Laparoscopic nerve-sparing radical hysterectomy for the treatment of cervical cancer: a meta-analysis of randomized controlled trials

Background: The effects and safety of laparoscopic nerve-sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH) in cervical cancer treatment remain unclear. This article aims to evaluate the role of LNSRH versus LRH in the treatment of cervical cancer. This is because the updated meta-analysis with synthesized data may provide more reliable evidence on the role of LNSRH and LRH. Methods: We searched Pubmed et al. databases for randomized controlled trials (RCTs) involving laparoscopic nerve-sparing radical hysterectomy (LNSRH) and laparoscopic radical hysterectomy (LRH) for cervical cancer treatment from the inception of databases to June 15, 2021. The RevMan 5.3 software was used for data analyses. This meta-analysis protocol had been registered online (available at: https://inplasy.com/inplasy-.2021-9-.0047/). Results: Thirteen RCTs involving a total of 1002 cervical cancer patients were included. Synthesized results indicated that the duration of surgery of the LNSRH group was significantly longer than that of the LRH group [SMD 1.11, 95% CI (0.15 similar to 2.07), P = 0.02]. The time to intestinal function recovery [SMD -1.27, 95% CI (-1.84 similar to -0.69), P < 0.001] and the time to postoperative urinary catheter removal of the LNSRH group [SMD -1.24, 95% CI (-1.62 similar to -0.86), P < 0.001] were significantly less than that of the LRH group. There were no significant differences in the estimated blood loss [SMD 0.10, 95% CI (-0.14 similar to 0.34), P = 0.41], the length of parauterine tissue resection [SMD -0.10, 95% CI (-0.25 similar to 0.05), P = 0.19], length of vaginal excision [SMD 0.04, 95% CI (-0.26 similar to 0.34), P = 0.78], and incidence of intraoperative adverse events [RR 0.97, 95% CI (0.44 similar to 2.13), P = 0.94] between the LNSRH group and the LRH group. Conclusions: LNSRH significantly results in earlier bladder and bowel function after surgery. Limited by sample size, LNSRH should be considered with caution in the future.