Long-term Pelvic Floor Function and Quality of Life After Radical Surgery for Cervical Cancer

Derks, Marloes; Velden, J. van der; Frijstein, Minke M.; Vermeer, Willemijn M.; Stiggelbout, Anne M.; Roovers, Jan Paul; Kroon, Cornelis D. de; Kuile, Moniek M. ter; Kenter, Gemma G.

doi:10.1097/igc.0000000000000776

Cited by 29 publications

(22 citation statements)

References 36 publications

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“…More extensive removal of the parametrium, especially the posterior VUL containing the hypogastric nerves running to the bladder, induces significantly more urinary dysfunction, although not significantly influencing quality of life, as was found when subgroups of the cohort described in this study were compared. 11,14,35 On the other hand, more radical surgery might decrease the need for adjuvant radiotherapy resulting in less radiotherapy-related side effects. 21,36 This latter issue is especially important in the debate about primary surgery or primary (chemo-)radiotherapy in stage IB2 cervix cancer, where many studies are published reporting a very high rate of adjuvant radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Early-Stage Cervical Cancer

Derks

Velden

Kroon

et al. 2018

International Journal of Gynecological Cancer

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This study confirms that variables such as large tumor diameter, nonsquamous histology, lymph vascular space invasion, deep stromal invasion, positive lymph nodes, and parametrial infiltration are poor prognostic variables in early cervix cancer treated by surgery. The extent of parametrectomy had no influence on survival in tumors of 20 mm or less. For larger tumors, a more radical hysterectomy might be associated with better DFS. Taking into account the possible bias in this study as a result of its retrospective design, ideally a prospective cohort study with clear definition of radicality is necessary to answer this important clinical question.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Early-Stage Cervical Cancer

Derks

Velden

Kroon

et al. 2018

International Journal of Gynecological Cancer

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“…In this study, we did not choose to add quality of life as an outcome measurement because these data have been published previously 3,4,20,21. Recently, Derks et al22 performed a quality of life study evaluating the quality of life after nonYnerve-sparing Wertheim Okabayashi versus nerve-sparing Wertheim Meigs, confirming urinary functions differing significantly where feeling of urine retention, less/no urge to void, and the need of timed voiding were more frequent in the Wertheim Okabayashi cohort.…”

mentioning

confidence: 92%

Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer

Gent¹,

Rademaker²,

Veer³

et al. 2017

International Journal of Gynecological Cancer

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“…For instance, radical hysterectomy is associated with high rates of micturition, defecation or sexual dysfunction (Ripperda et al, 2017). Although nerve-sparing techniques have reduced the incidence of disturbed urination (Ercoli et al, 2003;Fujii, 2008), 30% of the patients remain symptomatic (Derks et al, 2016), for example with reduced vaginal lubrication, 1 year after surgery (Jensen et al, 2004). So far, the structures of the female pelvis have been thoroughly investigated (Ripperda et al, 2017) but systematic data are limited for the entire female pelvis including anatomical variations (e.g.…”

Section: Introductionmentioning

confidence: 99%

Anatomy of the female pelvic nerves: a macroscopic study of the hypogastric plexus and their relations and variations

et al. 2020

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The autonomic nerves of the lesser pelvis are particularly prone to iatrogenic lesions due to their exposed position during manifold surgical interventions. Nevertheless, the cause of rectal and urinary incontinence or sexual dysfunctions, for example after rectal cancer resection or hysterectomy, remains largely understudied, particularly with regard to the female pelvic autonomic plexuses. This study focused on the macroscopic description of the superior hypogastric plexus, hypogastric nerves, inferior hypogastric plexus, the parasympathetic pelvic splanchnic nerves and the sympathetic fibres. Their arrangement is described in relation to commonly used surgical landmarks such as the sacral promontory, ureters, uterosacral ligaments, uterine and rectal blood vessels. Thirty‐one embalmed female pelvises from 20 formalin‐fixed and 11 Thiel‐fixed cadavers were prepared. In all cases explored, the superior hypogastric plexus was situated anterior to the bifurcation of the abdominal aorta. In 60% of specimens, it reached the sacral promontory, whereas in 40% of specimens, it continued across the pelvic brim until S1. In about 25% of the subjects, we detected an accessory hypogastric nerve, which has not been systematically described so far. It originated medially from the inferior margin of the superior hypogastric plexus and continued medially into the presacral space. The existence of an accessory hypogastric nerve was confirmed during laparoscopy and by histological examination. The inferior hypogastric plexuses formed fan‐shaped plexiform structures at the end of both hypogastric nerves, exactly at the junction of the ureter and the posterior wall of the uterine artery at the uterosacral ligament. In addition to the pelvic splanchnic nerves from S2–S4, which joined the inferior hypogastric plexus, 18% of the specimens in the present study revealed an additional pelvic splanchnic nerve originating from the S1 sacral root. In general, form, breadth and alignment of the autonomic nerves displayed large individual variations, which could also have a clinical impact on the postoperative function of the pelvic organs. The study serves as a basis for future investigations on the autonomic innervation of the female pelvic organs.

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Long-term Pelvic Floor Function and Quality of Life After Radical Surgery for Cervical Cancer

Abstract: Patients undergoing more radical surgery for early-stage cervical cancer report significantly more urinary dysfunction, whereas bowel function and health-related QoL are not decreased.

Cited by 29 publications

References 36 publications

Surgical Treatment of Early-Stage Cervical Cancer

Surgical Treatment of Early-Stage Cervical Cancer

Long-Term Oncological Outcome After Conventional Radical Hysterectomy Versus 2 Nerve-Sparing Modalities for Early Stage Cervical Cancer

Anatomy of the female pelvic nerves: a macroscopic study of the hypogastric plexus and their relations and variations

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