Hysterectomy and its impact on pelvic floor function
Last week at the European Society of Gynaecological Oncology Congress in Vienna I shared some exciting new research with some 3000 colleagues from all parts of the world on the impact of hysterectomy on pelvic floor function.
Pelvic floor function was assessed in patients in the LACE (Laparoscopic Approach to Cancer of the Endometrium) trial, a study run in Australia and internationally through the Queensland Centre for Gynaecological Cancer.
I posted a previous blog on the LACE trial, which compared patients’ survival outcomes of patients who had total abdominal versus total laparoscopic (keyhole) hysterectomy for endometrial cancer. Total laparoscopic hysterectomy was associated with better Quality of Life, less pain, shorter hospital stay and a lower incidence of complications. Total laparoscopic hysterectomy was also proven cost effective, saving funders of healthcare $4000 for every operation that is performed laparoscopically compared to abdominal surgery.
The LACE results of disease-free and overall survival were recently published in Journal of the American Medical Association, demonstrating equivalence of survival outcomes. Reassuringly, disease-free survival was virtually identical. It was 81.3% at 4.5 years in the abdominal surgery group and 81.6% in the laparoscopic group. These are very reassuring results for patients who need a hysterectomy for endometrial cancer.
Additionally in the LACE trial we investigated pelvic floor function after hysterectomy. Strong pelvic floor muscles provide control over the bladder and bowel. In women, pelvic floor muscles support the bladder, bowel and uterus. If pelvic floor muscles are weakened this means these organs are not fully supported and women may have symptoms such as difficulty controlling the release of urine or experience organ prolapse. Weak pelvic floor symptoms are more common in older women, those who are overweight, and women who have given natural births (the more natural births, the higher the risk).
Up until the LACE trial, the incidence of pelvic floor symptoms has not been reported in women who have undergone a total hysterectomy for endometrial cancer. There was a myth that after a hysterectomy, women are more likely to develop pelvic floor symptoms.
The LACE trial and pelvic floor symptoms
Interestingly, the LACE findings suggest that pelvic floor function in terms of urinary, bowel and prolapse symptoms are unlikely to worsen following abdominal or laparoscopic hysterectomy.
These findings are based on 381 patients with endometrial cancer (195 women had total abdominal hysterectomy and 186 women had total laparoscopic hysterectomy). Women in the LACE trial were asked to complete a Pelvic Floor Distress Inventory questionnaire before surgery, then at follow-up visits 6, 18, 30, 42, and 54 months after surgery. To note, at 6-months post-surgery both groups experienced an improvement in pelvic floor wellbeing compared to their pelvic floor wellbeing before surgery. There was no difference between laparoscopic and abdominal hysterectomy with respect to pelvic floor symptoms for up to 54 months post-surgery.
These findings are most reassuring for women undergoing hysterectomy for endometrial cancer that they should not expect a decline in pelvic floor symptoms due to surgery alone.
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