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Kállay É, Müller-Fabian A, Dégi CL. Fear of cancer progression and the quality of sexual life of female cancer patients in Romania. Front Public Health 2024; 12:1417681. [PMID: 38919914 PMCID: PMC11196963 DOI: 10.3389/fpubh.2024.1417681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Introduction As cancer survival rates increase, it has become crucial to pay attention to the long-term quality of life of survivors, including sexual functioning. The quality of sexual life and fear of cancer progression are often unmet needs, significantly impacting cancer patients' overall quality of life. In this study, we investigate these factors in Romanian female cancer patients and highlight their relationship with mental health and demographic variables. Methods This study included 242 Romanian female cancer patients who completed questionnaires assessing sexual functioning (EORTC QLQ-SHQ22), fear of cancer progression (FoP-Q), depression (PHQ-9), and anxiety (GAD-7). We examined these relationships using descriptive, exploratory, and regression analyses. Results Around 50% of patients reported impairments in sexual satisfaction and pain during sex. Lower sexual satisfaction increased sexual dysfunction, and heightened fear of cancer progression (FCP) were associated with depression, anxiety, younger age, lower education, rural residence, and unmarried status. Discussion This study reveals a complex interplay between sexual health, fear of cancer progression, and psychological well-being among female cancer survivors in Romania. Addressing sexual concerns, providing psychoeducation, promoting coping with the fear of progression, and utilizing interdisciplinary interventions are essential to improving these patients' overall quality of life. These findings underscore the need for integrated care approaches that consider both physical and psychological dimensions of cancer survivorship.
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Affiliation(s)
- Éva Kállay
- Babeș-Bolyai University, Psychology and Educational Sciences, Cluj-Napoca, Romania
| | | | - Csaba László Dégi
- Babeș-Bolyai University, Sociology and Social Work, Cluj-Napoca, Romania
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Chikazawa K, Muro S, Yamaguchi K, Imai K, Kuwata T, Konno R, Akita K. Denonvilliers' fascia as a potential nerve-course marker for the female urinary bladder. Gynecol Oncol 2024; 184:1-7. [PMID: 38271772 DOI: 10.1016/j.ygyno.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/04/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES This study investigated the relationship between Denonvilliers' fascia (DF) and the pelvic plexus branches in women and explored the possibility of using the DF as a positional marker in nerve-sparing radical hysterectomy (RH). METHODS This study included eight female cadavers. The DF, its lateral border, and the pelvic autonomic nerves running lateral to the DF were dissected and examined. The pelvis was cut into two along the mid-sagittal line. The uterine artery, deep uterine veins, vesical veins, and nerve branches to the pelvic organs were carefully dissected. RESULTS The nerves ran sagitally, while the DF ran perpendicularly to them. The rectovaginal ligament was continuous with the DF, forming a single structure. The DF attached perpendicularly and seamlessly to the pelvic plexus. The pelvic plexus branches were classified into a ventral part branching to the bladder, uterus, and upper vagina and a dorsal part branching to the lower vagina and rectum as well as into four courses. Nerves were attached to the rectovaginal ligament and ran on its surface to the bladder ventral to the DF. The uterine branches split from the common trunk of these nerves. The most dorsal branch to the bladder primarily had a common trunk with the uterine branch, which is the most important and should be preserved in nerve-sparing Okabayashi RH. CONCLUSION The DF can be used as a marker for nerve course, particularly in one of the bladder branches running directly superior to the DF, which can be preserved in nerve-sparing Okabayashi RH.
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Affiliation(s)
- Kenro Chikazawa
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan; Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Satoru Muro
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Kumiko Yamaguchi
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
| | - Ken Imai
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan.
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo City, Tokyo 113-8510, Japan.
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Taliento C, Scutiero G, Arcieri M, Pellecchia G, Tius V, Bogani G, Petrillo M, Pavone M, Bizzarri N, Driul L, Greco P, Scambia G, Restaino S, Vizzielli G. Simple hysterectomy versus radical hysterectomy in early-stage cervical cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108252. [PMID: 38471373 DOI: 10.1016/j.ejso.2024.108252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND This systematic review (SR) and meta-analysis aims to compare the surgery-related results and oncological outcomes between SH and RH in patients with early-stage cervical cancer. METHOD We systematically searched databases including PubMed, Embase and Cochrane to collect studies that compared oncological and surgery-related outcomes between SH and RH groups in patients with stage IA2 and IB1 cervical cancer. A random-effect model calculated the weighted average difference of each primary outcome via Review Manager V.5.4. RESULT Seven studies comprising 6977 patients were included into our study. For oncological outcomes, we found no statistical difference in recurrence rate [OR = 0.88; 95% CI (0.50, 1.57); P = 0.68] and Overall Survival (OS) [OR = 1.23; 95% CI (0.69, 2.19), P = 0.48]. No difference was detected in the prevalence of positive LVSI and lymph nodes metastasis between the two groups. Concerning surgery-related outcomes, the comprehensive effects revealed that the bladder injury [OR = 0.28; 95% CI (0.08, 0.94), P = 0.04] and bladder disfunction [OR = 0.10; 95% CI (0.02, 0.53), P = 0.007] of the RH group were higher compared to the SH group. CONCLUSION This meta-analysis suggested there are no significant differences in terms of both recurrence rate and overall survival among patients with stage IA2-IB1 cervical cancer undergoing SH or RH, while the SH group has better surgery-related outcomes. These data confirm the need to narrow the indication for RH in early-stage cervical cancer.
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Affiliation(s)
- C Taliento
- Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, Italy; Department of Development and Regeneration - Woman and Child, KU Leuven, Leuven, Belgium
| | - G Scutiero
- Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, Italy
| | - M Arcieri
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
| | - G Pellecchia
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
| | - V Tius
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
| | - G Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - M Petrillo
- Department of Obstetrics and Gynecology. University of Sassari, Sassari, Italy
| | - M Pavone
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy; Institute of Image-Guided Surgery, IHU Strasbourg, Strasbourg, France
| | - N Bizzarri
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - L Driul
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
| | - P Greco
- Department of Medical Sciences, Obstetrics and Gynecology Unit, University of Ferrara, Italy
| | - G Scambia
- Gynecologic Oncology Unit, Fondazione "Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - S Restaino
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Department of Obstetrics and Gynecology. University of Sassari, Sassari, Italy.
| | - G Vizzielli
- Clinic of Obstetrics and Gynecology, "Santa Maria Della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy; Medical Area Department (DAME), University of Udine, Udine, Italy
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Zeng WH, Liang Y, Zhou JQ, Lin HH, Huang LS, He DF, Wen JZ, Wu BM, Liu HC, Zhong YX, Lei NX, Yang HK. Comparison of the efficacy and safety of total laparoscopic hysterectomy without and with uterine manipulator combined with pelvic lymphadenectomy for early cervical cancer. J Obstet Gynaecol Res 2023; 49:2468-2474. [PMID: 37488971 DOI: 10.1111/jog.15749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/08/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVE Some studies have reported that the prognosis of total laparoscopic hysterectomy (TLH) for early-stage cervical cancer (CC) is worse than that of open surgery. And this was associated with the use of uterine manipulator or not. Therefore, this study retrospectively analyzes the efficacy and safety of TLH without uterine manipulator combined with pelvic lymphadenectomy for early-stage CC. METHODS Fifty-eight patients with CC (stage IB1-IIA1) who received radical hysterectomy from September 2019 to January 2020 were divided into no uterine manipulator (n = 26) and uterine manipulator group (n = 32). Then, clinical characteristics were collected and intraoperative/postoperative related indicators were compared. RESULTS Patients in the no uterine manipulator group had significantly higher operation time and blood loss than in the uterine manipulator group. Notably, there was no significant difference in hemoglobin change, blood transfusion rate, number of pelvic nodules, anal exhaust time, complications and recurrence rate between the two groups. Additionally, patients in the uterine manipulator group were prone to urinary retention (15.6%) and lymphocyst (12.5%), while the no uterine manipulator group exhibited high probability of bladder dysfunction (23.1%) and urinary retention (15.4%). Furthermore, the 1-year disease-free survival rate and the 1-year overall survival rate were not significantly different between the two groups. CONCLUSION There was no significant difference in the efficacy and safety of TLH with or without uterine manipulator combined with pelvic lymphadenectomy in the treatment of patients with early-stage CC. However, the latter requires consideration of the negative effects of high operation time and blood loss.
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Affiliation(s)
- Wei-Hong Zeng
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Ye Liang
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Jing-Qing Zhou
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Hai-Hong Lin
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Li-Shan Huang
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Dan-Feng He
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Ji-Zhong Wen
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Bo-Ming Wu
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Hao-Chang Liu
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Yao-Xiang Zhong
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Nan-Xiang Lei
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
| | - Hai-Kun Yang
- Department of Gynecology, Meizhou People's Hospital (Meizhou Academy of Medical Sciences), Meizhou, Guangdong, China
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Cai L, Wu Y, Xu X, Cao J, Li D. Pelvic floor dysfunction in gynecologic cancer survivors. Eur J Obstet Gynecol Reprod Biol 2023; 288:108-113. [PMID: 37499277 DOI: 10.1016/j.ejogrb.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/06/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023]
Abstract
Pelvic floor dysfunction (PFD) is a common complication in gynecologic cancer survivors (GCS) and is now a worldwide medical and public health problem because of its great impact on the quality of life of GCS. PFD after comprehensive gynecologic cancer treatment is mainly reflected in bladder function, rectal function, sexual dysfunction and pelvic organ prolapse (POP), of which different types of gynecologic cancer correspond to different disease incidence. The prevention strategies of PFD after comprehensive gynecologic cancer treatment mainly included surgical treatment, physical therapy and behavioral guidance, etc. At present, most of them still focus on physical therapy, mostly using Pelvic Floor Muscle Training (PFMT) and multi-modal PFMT treatment of biofeedback combined with electrical stimulation, which can reduce the possibility of PFD after surgery in GCS to some extent. This article reviews the clinical manifestations, causes and current research progress of prevention and treatment methods of PFD after comprehensive treatment for GCS.
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Affiliation(s)
- Linjuan Cai
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Yue Wu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Xuyao Xu
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China
| | - Jian Cao
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China.
| | - Dake Li
- Department of Gynecology, Women's Hospital of Nanjing Medical University (Nanjing Maternity and Child Health Care Hospital), Nanjing 210004, People's Republic of China.
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Prevalence of pelvic floor dysfunction and sexual dysfunction in cervical cancer survivors: a systematic review and meta-analysis. Int Urogynecol J 2023; 34:655-664. [PMID: 36001098 DOI: 10.1007/s00192-022-05326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/31/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic floor dysfunction (PFD) and female sexual dysfunction (FSD) are symptoms that affect the quality of life of patients with cervical cancer (CC) after treatment. Our purpose was to estimate the prevalence of urinary incontinence (UI) and fecal incontinence (FI) associated with PFD and prevalence of FSD in CC patients. METHODS We searched PubMed, Embase, and the Cochrane Library from database inception to 31 January 2021 and selected articles assessing UI, FI and FSD in women with CC. Observational studies were included if they investigated UI, FI, and FSD. RESULTS We included 14 of the 1,233 studies: 7 investigated FSD, 9 UI, and 3 FI. The results were highly heterogeneous because of the different populations and treatment methods. The prevalence of FSD, UI, and FI in CC patients after treatment was 45.0% (95% CI, 21.8-68.3%), 34.1% (95% CI, 25.5-42.7%), and 11.1% (95% CI, 4.8-17.3%). The results showed that different countries were the source of high heterogeneity of UI and FI (P<0.001). CONCLUSIONS In this meta-analysis, the prevalence of PFD and FSD was high. These results are important for drawing attention to PFD and its early prevention and rehabilitation.
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Sousa Rodrigues Guedes T, Barbosa Otoni Gonçalves Guedes M, de Castro Santana R, Costa da Silva JF, Almeida Gomes Dantas A, Ochandorena-Acha M, Terradas-Monllor M, Jerez-Roig J, Bezerra de Souza DL. Sexual Dysfunction in Women with Cancer: A Systematic Review of Longitudinal Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11921. [PMID: 36231221 PMCID: PMC9564951 DOI: 10.3390/ijerph191911921] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Several factors affect sexual function, including cancer development and treatment. This study summarized the risk of women with cancer of developing sexual dysfunctions. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the EMBASE, PubMed, LILACS, SciELO, CINAHL, Scopus, and Web of Science databases using the descriptors cancer, neoplasms, sexual dysfunction, sexual function, and women. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies assessed the quality of studies. RESULTS Sixteen studies were included in this review. Women with cancer presented sexual dysfunctions in 14 out of 16 included studies. The incidence of sexual dysfunctions ranged from 30% to 80%, while the risk of developing sexual dysfunction increased 2.7- and 3.5-fold in women with cervical and breast cancer, respectively. CONCLUSION Different cancer treatments increase the risk of developing sexual dysfunction in women, especially desire, arousal, and orgasm, leading to biopsychosocial changes in the health of this population.
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Affiliation(s)
- Thais Sousa Rodrigues Guedes
- Graduate Program in Health Science, Center of Health Science, Federal University of Rio Grande do Norte (UFRN), Campus Universitário Lagoa Nova, Natal 1524, Brazil
| | | | - Rebeca de Castro Santana
- Department of Physiotherapy, Federal University of Rio Grande do Norte (UFRN), Campus Universitário Lagoa Nova, Natal 1524, Brazil
| | - José Felipe Costa da Silva
- Department of Public Health, Graduate Program in Health Science, Federal University of Rio Grande do Norte (UFRN), Campus Universitário Lagoa Nova, Natal 1524, Brazil
| | - Amanda Almeida Gomes Dantas
- Graduate Program in Health Science, Center of Health Science, Federal University of Rio Grande do Norte (UFRN), Campus Universitário Lagoa Nova, Natal 1524, Brazil
| | - Mirari Ochandorena-Acha
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, 08500 Vic, Spain
| | - Marc Terradas-Monllor
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, 08500 Vic, Spain
| | - Javier Jerez-Roig
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), C. Sagrada Família, 7, 08500 Vic, Spain
| | - Dyego Leandro Bezerra de Souza
- Department of Public Health, Graduate Program in Health Science, Federal University of Rio Grande do Norte (UFRN), Campus Universitário Lagoa Nova, Natal 1524, Brazil
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Wei WW, Wang H, Zheng H, Chen J, Shi RX. Survival Impacts of Perineural Invasion on Patients Under Different Radical Hysterectomies Due to Early Cervical Cancer. Front Oncol 2022; 12:889862. [PMID: 35574312 PMCID: PMC9103185 DOI: 10.3389/fonc.2022.889862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022] Open
Abstract
Objective Cervical cancer is a common gynecological malignancy. In addition to the open radical hysterectomy (ORH) and laparoscopic radical hysterectomy (LRH), laparoscopic nerve-sparing radical hysterectomy (LNSRH) could be another treatment option since it could preserve urinary, colorectal, and sexual functions. However, LNSRH might result in early cancer metastasis and recurrence due to inadequate tumor resection. Additionally, whether LNSRH should be considered based on perineural invasion (PNI) status remains controversial. To assess different types of hysterectomy on the outcome of early cervical cancer with PIN. Methods A retrospective study was performed in early cervical cancer patients who received ORH, LRH, or LNSRH between January 2012 and December 2019. Age, FIGO cancer stages, histopathological types, tumor size, histological grade, invasion depth, lymph node metastasis, lymphovascular space invasion, and PNI were documented. Disease-free survival (DFS) and overall survival (OS) were recorded. Results A total of 174 patients were included, with 33, 69, and 72 patients received LRH, ORH, and LNSRH, respectively. Twenty-one patients (12.1%) had PNI. DFS (P = 0.000) and OS (P = 0.022) periods were shortened in positive PNI patients than in negative PNI patients (P = 0.000 and 0.022, respectively). In patients with positive PNI, lymph node metastasis, but not the surgery type, was an independent risk factor for DFS and OS (P = 0.000). Conclusion Early cervical cancer patients with PNI had shorter postoperative DFS and OS periods. In these patients, lymph node metastasis, but not the type of hysterectomy, was independently associated with DFS and OS.
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Affiliation(s)
| | | | | | | | - Ru-xia Shi
- *Correspondence: Jiming Chen, ; Ru-xia Shi,
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Liu Y, Chen G, Gao J, Chi M, Mao M, Shi Y, Ji Z, Fu Q, Zhang H, Xu Z. Effect of different levels of stroke volume variation on the endothelial glycocalyx of patients undergoing colorectal surgery: A randomized clinical trial. Exp Physiol 2021; 106:2124-2132. [PMID: 34347918 DOI: 10.1113/ep089348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/03/2021] [Indexed: 12/28/2022]
Abstract
NEW FINDINGS What is the central question of this study? Massive infusion can destroy the endothelial glycocalyx. We compared the serum concentrations of endothelial glycocalyx components and atrial natriuretic peptide and the outcomes of patients with different levels of stroke volume variation (SVV). What is the main finding and its importance? With a decrease in SVV, the serum concentrations of endothelial glycocalyx components and atrial natriuretic peptide increased, whereas the oxygenation index decreased. When the intraoperative SVV was maintained at 7-10%, the patients had better postoperative recovery and shorter postoperative hospital stays. Therefore, it is advisable to maintain the SVV between 7 and 10%. ABSTRACT Dynamic haemodynamic parameters, such as stroke volume variation (SVV), can be used for blood volume monitoring. However, studies have determined the SVV threshold but not the optimal level. The endothelial glycocalyx (EG) plays an important role in maintaining vascular permeability. Moreover, rapid and massive infusion can lead to the degradation, shedding and destruction of the EG. We aimed to explore the effects of different SVV values (11-14, 7-10 or 3-6%) on the EG in 54 patients who were scheduled for elective colorectal tumour surgery and to identify the optimal peri-operative fluid therapy strategy. The concentrations of EG degradation products (heparin sulphate, hyaluronic acid and syndecan-1) and atrial natriuretic peptide were higher when the SVV was maintained between 3 and 6% after fluid therapy compared with pre-infusion (P < 0.05). Comparison of postoperative complications and hospitalization time among the three SVV levels was not statistically significant (P > 0.05). The postoperative hospitalization time in patients with SVV of 7-10% was shorter than that in patients with SVV of 3-6%. Infusion of a large volume of fluid, with increasing EG degeneration and atrial natriuretic peptide concentrations, might be related to postoperative outcomes.
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Affiliation(s)
- Yi Liu
- Department of Anesthesiology, The Third Medical Center of Chinese PLA General Hospital, No. 69 Yongding Road, Beijing, 100039, China.,Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Gang Chen
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Jie Gao
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Menglin Chi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Mengmeng Mao
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Yizheng Shi
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Zexuan Ji
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Qiang Fu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Hong Zhang
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Zhipeng Xu
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
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