Quality of life and long-term clinical outcome following robot-assisted radical trachelectomy. (December 2021)

• Record Type: Journal Article
• Authors: Ekdahl, Linnea; Crusensvärd, Malin; Reynisson, Petur; Lönnerfors, Celine; Persson, Jan
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 267(2021)
• Page Start: 234
• Page End: 240
• Publication Date: 2021-12
• Subjects: RRT Robot-assisted radical trachelectomy -- RH Radical hysterectomy -- RT Radical trachelectomy -- VRT Vaginal radical trachelectomy -- GW Gestational week -- SLN Sentinel lymph node -- ICG Indocyanine green -- ARH Abdominal radical hysterectomy -- GHS Global health status; Quality of Life -- Sexual function -- Lymphedema -- Robot-assisted radical trachelectomy; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2021.11.018
• Languages: English
• ISSNs: 0301-2115

Abstract

Highlights: Sexual functioning and worry of dyspareunia were the most common QoL related symptoms. Lymphedema was reported in 45%, where 9% reported symptoms as severe. The rate of recurrence was 2% after a median follow-up of 54 months. Seventy-nine percent of women who attempted to conceive were successful. Ninety-two percent delivered at ≥ 36 GW after a metronidazole/sexual abstinence regime. Abstract: Quality of Life and long-term clinical outcome following robot-assisted radical trachelectomy. Objectives: To evaluate quality of life (QoL) and long-term clinical outcome following robot-assisted radical trachelectomy (RRT). Study Design: Prospectively retrieved clinical data were rereviewed on all women planned for a fertility sparing RRT for early stage cervical cancer at Skåne University Hospital, Sweden between 2007 and 2020. QoL was assessed using the validated questionnaires EORTC QLQ-C30, QLQ-CX24 and the Swedish LYMQOL. Results: Data was analyzed from 49 women, 42 with a finalised RRT and seven with an aborted RRT due to nodal metastases ( n = 3) or insufficient margins ( n = 4). At a median follow-up time of 54 months one recurrence (2%) occurred (aborted RRT). According to QLQ-C30 the median global health status score was 75. The disease specific QLQ-C24 showed an impact on symptoms related to sexual function where sexual/vaginal functioning had a median score of 25 and 48% of patients reported worry that sex would cause physical pain. Despite this the functional items sexual activity and sexual enjoyment both had a median score of 66.7. Lymphoedema was reported in 45%, where 9% reported severe symptom with an impact on their QoL. No intraoperative complications and no postoperative complications ≥ Clavien Dindo grade III were observed. Twenty-two of 28 (79%) women who attempted to conceive were successful. A metronidazole/no intercourse regimen was applied between GW 15 + 0–21 + 6 in 26 of 28 pregnancies beyond first trimester resulting in a 92% term (≥GW 36 + 0) delivery rate. Conclusions: Although robot-assisted radical trachelectomy in this cohort was associated with a low recurrence rate, a high fertility rate and an exceptionally high term delivery rate, women's quality of life was affected postoperatively, particularly with regards to their sexual well-being and lymphatic side-effects.