Sexual functioning and vaginal changes after radical vaginal trachelectomy in early stage cervical cancer patients: a longitudinal study.

INTRODUCTION: Radical vaginal trachelectomy (RVT) offers low complication rate, good survival, and possibility for future childbearing for young women with early stage cervical cancer. However, the literature on quality of life (QOL) and sexual functioning in patients undergoing RVT is scarce. AIM: The aims of this study were to prospectively assess sexual function after RVT and to compare scores of sexual function in patients operated by RVT and radical abdominal hysterectomy (RAH) with those of age-matched control women from the general population. METHODS: Eighteen patients with early stage cervical cancer operated with RVT were prospectively included and assessed preoperatively, and 3, 6, and 12 months postoperatively using validated questionnaires. RAH patients were included consecutively and assessed once at 12 months postsurgery, while an age-matched control group of 30 healthy women was assessed once. MAIN OUTCOME MEASURE: Sexual dysfunction total score as measured by the Female Sexual Function Index (FSFI) was the main outcome measure. RESULTS: During the 12 months posttreatment, RVT patients tended to have persistent sexual dysfunction as measured by FSFI (mean overall score <26.55 at each assessment) and Female Sexual Distress Scale (mean overall score > 11). Sexual worry (P < 0.001) and lack of sexual desire (P = 0.038) were more frequently reported among patients in both treatment groups compared with control women. Sexual activity increased significantly during the observation time for the RVT group (P = 0.023) and reached that of healthy women. Global Health Status score improved over time for the RVT group but never reached that of healthy control women (P = 0.029). CONCLUSIONS: Our data suggest that patients treated with RVT for early stage cervical cancer experience persistent sexual dysfunction up to one year post surgery influencing negatively on their QOL.

The value of gynecologic cancer follow-up: evidence-based ignorance?

INTRODUCTION: To explore the extent of evidence-based data and cost-utility of follow-up after primary treatment of endometrial and ovarian cancer, addressing perspectives of technology, organization, economics, and patients. METHODS: Systematic literature searches according to the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions were conducted separately for each of the 4 perspectives. In addition, the organizational analysis included a nationwide questionnaire survey among all relevant hospital departments, and the operating costs were calculated. RESULTS: None of the identified studies supported a survival benefit from hospital-based follow-up after completion of primary treatment of endometrial or ovarian cancer. The methods for follow-up were of low technology (gynecologic examination with or without ultrasound examination). Other technologies had poor sensitivity and specificity in detecting recurrence. Small changes in applied technologies and organization lead to substantial changes in costs. Substantial differences especially in frequency and applied methods were found between departments. The literature review did not find evidence that follow-up affects the women's quality of life. CONCLUSIONS: The main purpose of follow-up after treatment of cancer is improved survival. Our review of the literature showed no evidence of a positive effect on survival in women followed up after primary treatment of endometrial or ovarian cancer. The conception of follow-up among physicians, patients, and their relatives therefore needs revision. Follow-up after treatment should have a clearly defined and evidence-based purpose. Based on the existing literature, this purpose should presently focus on other end points rather than early detection of relapse and improved survival. These end points could be quality of life, treatment toxicity, and economy.

[Laparoscopically assisted vaginal hysterectomy in preoperative and peroperative assessment of stage I endometrial cancer]. / Laparoskopisk assisteret vaginal hysterektomi ved prae- og peroperativt vurderet stadium I-endometriecancer.

OBJECTIVE: The aim of this study was to evaluate the feasibility and safety of laparoscopically assisted vaginal hysterectomy (with and without pelvic lymphadenectomy) in the staging and treatment of stage I endometrioid endometrial cancer. MATERIALS AND METHODS: A prospective series of consecutive patients with primary operable endometrial cancer referred to Odense University Hospital between 01.01.2006 and 31.03.2007. All patients were evaluated and a laparoscopic treatment was planned when considered appropriate. RESULTS: 72 consecutive patients with primary operable endometrial cancer were included in the study. 35 patients (48%) were successfully treated with a laparoscopically assisted vaginal hysterectomy. 12 (34%) of them were also treated with a pelvic lymphadenectomy. The median number of lymph nodes removed was 15 (range 10-32). The median operating time was 80 minutes (60-180) without lymphadenectomy and 140 (105-200) minutes with lymphadenectomy. No intraoperative or serious postoperative complications were registered. 26 (74%) out of 35 patients treated by laparoscopy were discharged on the first or second postoperative day. CONCLUSION: We conclude that laparoscopically assisted vaginal hysterectomy is a safe and effective alternative to laparotomy in the staging and treatment of stage I endometrioid endometrial cancer.