Postoperative Health-Related Quality of Life of Cervical Cancer Patients – A Comparison between the Wertheim-Meigs Operation and Total Mesometrial Resection (TMMR)

 

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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.

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