Subscribe to RSS
DOI: 10.1055/s-0034-1368600
Postoperative Health-Related Quality of Life of Cervical Cancer Patients – A Comparison between the Wertheim-Meigs Operation and Total Mesometrial Resection (TMMR)
Die postoperative gesundheitsbezogene Lebensqualität von Zervixkarzinompatientinnen – Ein Vergleich zwischen der Wertheim-Meigs-Operation und der Totalen Mesometrialen Resektion (TMMR)Publication History
received 20 December 2013
revised 14 May 2014
accepted 20 May 2014
Publication Date:
01 August 2014 (online)
Abstract
Introduction: The present study compares for the first time the standard therapy for cervical cancer in FIGO-stages IB-IIB, radical hysterectomy according to the Wertheim-Meigs operation, with the newly developed, nerve-sparing surgical technique, total mesometrial resection (TMMR) with regard to postoperative, health-related quality of life. Method: In the framework of a multicentre, retrospective cohort study a total of 110 cervical cancer patients were interviewed once by means of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the cervical cancer module (EORTC QLQ-CX24). The influence of the surgical method was investigated by analysis of covariance under control of age and the time elapsed between treatment and interview. Results: An influence of the therapeutic method was demonstrated in the EORTC scales physical function (p = 0.047), role function (p = 0.016), fatigue (p = 0.028), pain (p = 0.018), shortness of breath (p = 0.034), lack of appetite (p = 0.006) and diarrhoea (p = 0.012) in favour of the 74 women treated by TMMR. With regard to cognitive, emotional and social functioning as well as cervical cancer-specific symptoms, no significant differences between the therapy groups were found. Conclusion: The findings presented in this study suggest a superiority of TMMR in comparison to the previously employed radical hysterectomy according to Wertheim-Meigs with regard to the postoperative quality of life, especially in the fields of physical activity and fatigue. This needs to be validated in the course of prospective, multicentre studies. In addition, it must be clarified as to what extent the found effects are, in particular, due to the omission of an additional radiotherapy.
Zusammenfassung
Einleitung: Die vorliegende Studie vergleicht erstmals die Standardtherapie des Zervixkarzinoms der FIGO-Stadien IB–IIB, die radikale Hysterektomie nach Wertheim-Meigs-Operation, mit der neu entwickelten nervenschonenden Operationstechnik, der totalen mesometrialen Resektion (TMMR) hinsichtlich der postoperativen gesundheitsbezogenen Lebensqualität. Methode: Im Rahmen einer multizentrischen, retrospektiven Kohortenstudie wurden insgesamt 110 Zervixkarzinompatientinnen postoperativ einmalig mit dem European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) und dem Zervixkarzinom-Modul (EORTC QLQ-CX24) befragt. Der Einfluss der Operationsmethode wurde mittels Kovarianzanalysen unter Kontrolle des Lebensalters und der vergangenen Zeit zwischen Therapie und Interview untersucht. Ergebnisse: Es zeigte sich ein Einfluss der Therapiemethode in den EORTC-Skalen körperliche Funktion (p = 0,047), Rollenfunktion (p = 0,016), Fatigue (p = 0,028), Schmerzen (p = 0,018), Kurzatmigkeit (p = 0,034), Appetitlosigkeit (p = 0,006) und Diarrhö (p = 0,012) zugunsten der 74 TMMR-behandelten Frauen. Bezüglich der kognitiven, emotionalen und sozialen Funktionsfähigkeit sowie zervixkarzinomspezifischer Symptome wurden keine signifikanten Unterschiede zwischen den Therapiegruppen gefunden. Schlussfolgerung: Die vorliegenden Befunde legen eine Überlegenheit der TMMR im Vergleich zur bisherigen radikalen Hysterektomie nach Wertheim-Meigs bezüglich der postoperativen Lebensqualität, insbesondere im körperlichen Bereich und der Fatigue, nahe. Dies sollte im Rahmen von prospektiven, multizentrischen Studien verifiziert werden. Zudem sollte geklärt werden, inwieweit die gefundenen Effekte insbesondere auf den Verzicht einer zusätzlichen Strahlentherapie zurückzuführen sind.
-
References
- 1 Robert Koch-Institut, Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V., Hrsg. Krebs in Deutschland 2007/2008. 8. Ausgabe. Berlin: 2012
- 2 Waldmann A, Eisemann N, Katalinic A. Epidemiology of malignant cervical, corpus uteri and ovarian tumours – current data and epidemiological trends. Geburtsh Frauenheilk 2013; 73: 123-129
- 3 Walboomers JM, Jacobs MV, Manos MM et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189: 12-19
- 4 Simoes E, Brucker S, Beckmann MW et al. Screening for cervical cancer – minimise risks – maximise benefits. Need for adaptation in Germany in light of the European guidelines and their objectives. Geburtsh Frauenheilk 2013; 73: 623-639
- 5 Simoes E, Brucker S, Beckmann MW et al. Cervical cancer screening: defining the need for research. Geburtsh Frauenheilk 2013; 73: 239-246
- 6 Juhasz-Böss I, Mallmann P, Möller CP et al. Use of laparoscopy in the treatment of endometrial and cervical cancer – results of a 2012 Germany-wide survey. Geburtsh Frauenheilk 2013; 73: 911-917
- 7 Beckmann MW, Mallmann P. Interdisciplinary S2 k guideline on the diagnosis and treatment of cervical carcinoma. J Cancer Res Clin Oncol 2009; 35: 1197-1206
- 8 Mangler M, Zech N, Schneider A et al. Aspects of therapy for cervical cancer in Germany 2012 – Results from a survey of German gynaecological hospitals. Geburtsh Frauenheilk 2013; 73: 227-238
- 9 Höckel M, Horn LC, Fritsch H. Association between the mesenchymal compartment of uterovaginal organogenesis and local tumour spread in stage IB-IIB cervical carcinoma: a prospective study. Lancet Oncol 2005; 6: 751-756
- 10 Höckel M, Horn LC, Manthey N et al. Resection of the embryologically defined uterovaginal (Mullerian) compartment and pelvic control in patients with cervical cancer: a prospective analysis. Lancet Oncol 2009; 10: 683-692
- 11 Matsuura Y, Kawagoe T, Toki N et al. Long-standing complications after treatment for cancer of the uterine cervix–clinical significance of medical examination at 5 years after treatment. Int J Gynecol Cancer 2006; 16: 294-297
- 12 Kashima K, Yahata T, Fujita K et al. Analysis of the complications after radical hysterectomy for stage IB, IIA and IIB uterine cervical cancer patients. J Obstet Gynaecol Res 2010; 36: 555-559
- 13 Landoni F, Maneo A, Colombo A et al. Randomised study of radical surgery versus radiotherapy for stage Ib-II a cervical cancer. Lancet 1997; 350: 535-540
- 14 Undurraga M, Loubeyre P, Dubuisson JB et al. Early-stage cervical cancer: is surgery better than radiotherapy?. Expert Rev Anticancer Ther 2010; 10: 451-460
- 15 Vrzackova P, Weiss P, Cibula D. Sexual morbidity following radical hysterectomy for cervical cancer. Expert Rev Anticancer Ther 2010; 10: 1037-1042
- 16 Baalbergen A, Veenstra Y, Stalpers LL et al. Primary surgery versus primary radiation therapy with or without chemotherapy for early adenocarcinoma of the uterine cervix. Cochrane Database Syst Rev 2010; (1) CD006248
- 17 Goncalves V. Long-term quality of life in gynecological cancer survivors. Curr Opin Obstet Gynecol 2010; 22: 30-35
- 18 Park SY, Bae DS, Nam JH et al. Quality of life and sexual problems in disease-free survivors of cervical cancer compared with the general population. Cancer 2007; 110: 2716-2725
- 19 Hsu WC, Chung NN, Chen YC et al. Comparison of surgery or radiotherapy on complications and quality of life in patients with the stage IB and IIA uterine cervical cancer. Gynecol Oncol 2009; 115: 41-45
- 20 Ebert AD, Ulrich U, Beckmann MW et al. [Unanswered questions in the management of cervical cancer]. Zentralbl Gynakol 2006; 128: 23-26
- 21 Dursun P, Ayhan A, Kuscu E. New surgical approaches for the management of cervical carcinoma. Eur J Surg Oncol 2008; 34: 487-496
- 22 Dursun P, Ayhan A, Kuscu E. Nerve-sparing radical hysterectomy for cervical carcinoma. Crit Rev Oncol Hematol 2009; 70: 195-205
- 23 Rob L, Halaska M, Robova H. Nerve-sparing and individually tailored surgery for cervical cancer. Lancet Oncol 2010; 11: 292-301
- 24 Ditto A, Martinelli F, Borreani C et al. Quality of life and sexual, bladder, and intestinal dysfunctions after class III nerve-sparing and class II radical hysterectomies: a questionnaire-based study. Int J Gynecol Cancer 2009; 19: 953-957
- 25 Raspagliesi F, Ditto A, Fontanelli R et al. Nerve-sparing radical hysterectomy: a surgical technique for preserving the autonomic hypogastric nerve. Gynecol Oncol 2004; 93: 307-314
- 26 Raspagliesi F, Ditto A, Kusamura S. Nerve-sparing radical hysterectomy: a pilot study. Tumor 2003; 89: 497-501
- 27 Wu J, Liu X, Hua K et al. Effect of nerve-sparing radical hysterectomy on bladder function recovery and quality of life in patients with cervical carcinoma. Int J Gynecol. Cancer 2010; 20: 905-909
- 28 Fujii S. Anatomic identification of nerve-sparing radical hysterectomy: a step-by-step procedure. Gynecol Oncol 2008; 111 (2 Suppl.) S33-S41
- 29 Fujii S, Takakura K, Matsumura N. Anatomic identification and functional outcomes of the nerve sparing Okabayashi radical hysterectomy. Gynecol Oncol 2007; 107: 4-13
- 30 Aaronson NK, Ahmedzai S, Bergman B et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365-376
- 31 Greimel ER, Kuljanic VK, Waldenstrom AC et al. The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life questionnaire cervical cancer module: EORTC QLQ-CX24. Cancer 2006; 107: 1812-1822
- 32 Singer S, Kuhnt S, Momenghalibaf A et al. Patientsʼ acceptance and psychometric properties of the EORTC QLQ-CX24 after surgery. Gynecol Oncol 2010; 116: 82-87
- 33 Osoba D, Rodrigues G, Myles J et al. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 1998; 16: 139-144
- 34 Greimel ER, Winter R, Kapp KS et al. Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study. Psychooncology 2009; 18: 476-482
- 35 Miller BE, Pittman B, Case D et al. Quality of life after treatment for gynecologic malignancies: a pilot study in an outpatient clinic. Gynecol Oncol 2002; 87: 178-184
- 36 Frumovitz M, Sun CC, Schover LR. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol 2005; 23: 7428-7436
- 37 Korfage IJ, Essink-Bot ML, Mols F. Health-related quality of life in cervical cancer survivors: a population-based survey. Int J Radiat Oncol Biol Phys 2009; 73: 1501-1509
- 38 Bloom JR, Petersen DM, Kang SH. Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psychooncology 2007; 16: 691-706
- 39 Vistad I, Fossa SD, Kristensen GB et al. Chronic fatigue and its correlates in long-term survivors of cervical cancer treated with radiotherapy. BJOG 2007; 114: 1150-1158
- 40 Jereczek-Fossa BA, Marsiglia HR, Orecchia R. Radiotherapy-related fatigue. Crit Rev Oncol Hematol 2002; 41: 317-325
- 41 Vistad I, Cvancarova M, Fossa SD et al. Postradiotherapy morbidity in long-term survivors after locally advanced cervical cancer: how well do physiciansʼ assessments agree with those of their patients?. Int J Radiat Oncol Biol Phys 2008; 71: 1335-1342
- 42 Pieterse QD, Maas CP, Ter Kuile MM et al. An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer. Int J Gynecol Cancer 2006; 16: 1119-1129
- 43 Bradley S, Rose S, Lutgendorf S et al. Quality of life and mental health in cervical and endometrial cancer survivors. Gynecol Oncol 2006; 100: 479-486
- 44 Klee M, Thranov I, Machin D. Life after radiotherapy: the psychological and social effects experienced by women treated for advanced stages of cervical cancer. Gynecol Oncol 2000; 76: 5-13