Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
Department of Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
Gynecol Oncol. 2018 Jun;149(3):484-490. doi: 10.1016/j.ygyno.2018.03.054. Epub 2018 Apr 2.
Pelvic exenteration (PE) is a surgical procedure associated with significant morbidity offered to select women with locally advanced or recurrent gynecologic cancers. This ongoing study examines an array of patient-reported outcomes and satisfaction with PE.
Since February 2009, prospectively enrolled participants completed questionnaires evaluating body image (BIS), depression (CESD), social support (DUFSS), symptoms (MDASI), sexual function (SAQ), functional status (SF-12), quality of life (The Stoma-QOL), satisfaction with decision (SWD) and an investigator-designed survey at baseline, 6, and 12months after PE. Mann-Whitney and Wilcoxon signed-rank tests were used to evaluate the data.
Fifty-four women enrolled. Median age was 56years (31, 85). Median BMI was 30.7kg/m (16.8, 54.4). The majority of patients (78%) were white. Cancer diagnoses included 41% cervix, 22% uterus, 19% vagina, 17% vulva and 2% ovary. Most surgeries were total PEs (76%). Patients were satisfied with their decision to undergo PE at 6 and 12months. One year after exenteration, 79% of women stated they would have a PE again. Sexual pleasure decreased from baseline to 12months after PE (p=0.02), while sexual discomfort remained unchanged (p=0.42). Body image worsened over time (p=0.003). Physical functioning (SF-12) declined (p=0.001), while mental functioning remained stable (p=0.46). There were no significant changes in stoma-related QOL, social support, or depression scores.
Despite a decrease in physical functioning, persistent low body image and sexual pleasure, most women were satisfied with their decision and would undergo pelvic exenteration again. This study identifies survivorship issues that should be addressed after PE.
盆腔廓清术（PE）是一种与显著发病率相关的手术，仅提供给少数局部晚期或复发性妇科癌症患者。本研究正在调查一系列患者报告的结局和对 PE 的满意度。
自 2009 年 2 月以来，前瞻性入组的参与者完成了评估体像（BIS）、抑郁（CESD）、社会支持（DUFSS）、症状（MDASI）、性功能（SAQ）、功能状态（SF-12）、生活质量（Stoma-QOL）、决策满意度（SWD）以及研究者设计的调查的问卷。在 PE 前、6 个月和 12 个月时进行基线评估。采用 Mann-Whitney 和 Wilcoxon 符号秩检验进行数据分析。
共有 54 名女性入组。中位年龄为 56 岁（31，85）。中位 BMI 为 30.7kg/m（16.8，54.4）。大多数患者（78%）为白人。癌症诊断包括 41%的宫颈癌、22%的子宫癌、19%的阴道癌、17%的外阴癌和 2%的卵巢癌。大多数手术为全盆腔廓清术（76%）。患者在 6 个月和 12 个月时对接受 PE 的决定表示满意。1 年后，79%的女性表示会再次接受 PE。PE 后 12 个月时，性愉悦感较基线下降（p=0.02），而性不适保持不变（p=0.42）。体像随时间恶化（p=0.003）。身体机能（SF-12）下降（p=0.001），而心理机能保持稳定（p=0.46）。在与造口相关的生活质量、社会支持或抑郁评分方面没有显著变化。
尽管身体机能下降、持续的低体像和性愉悦感，但大多数患者对其决策表示满意，并会再次接受盆腔廓清术。本研究确定了 PE 后应解决的生存问题。
