Numerous trials have concluded that laparoscopic hysterectomy, compared with total abdominal hysterectomy, causes less postoperative pain and shortens the hospital stay. Many view this approach as being more cost-effective, but a recent large, randomized trial demonstrated more major complications after the laparoscopic procedure. The present study compared the length of time in the hospital, time to convalescence, and long-term patient satisfaction in 47 consecutive women who were to have supravaginal hysterectomy. Twenty-three of them were randomized to undergo abdominal supravaginal hysterectomy (ASH) and 24 laparoscopic supravaginal hysterectomy (LSH). Pre-and postoperative procedures were comparable in the 2 groups, and there were no significant differences in demographic features or physical characteristics.The postoperative hospital stay was comparable after ASH and LSH. Operating times were significantly longer with LSH, but estimated blood loss was greater in the ASH group. No intraoperative complications occurred in either group, and no patient was transfused. Self-rated pain 6 hours postoperatively was less in women having LSH. Follow up at 6 weeks showed that patients having ASH required approximately 10 more disability days than those in the LSH group. There were no differences in the number of days analgesics were required or the time needed to resume normal activities. At 6 months, 87% of women having ASH and 91% of those in the LSH group were satisfied or very satisfied with the overall results. More than 90% of women in both groups would recommend their procedure to others.When using a multimodal intervention program of postoperative care, the choice between ASH or LSH may be less important than is generally believed with regard to postoperative time in the hospital and long-term patient satisfaction. EDITORIAL COMMENT(What is with the idea of supracervical hysterectomy? There may be some patients who think that preservation of the cervix has less risk of interfering with sexual function or producing urinary incontinence. However, several prospective, randomized trials from the United States, Holland, England, and Denmark have shown that these ideas are not true-preservation of the cervix does not help with sexual, bladder, or bowel function.Learman et al reported on a relatively small, prospectively randomized series of 135 women from 4 U.S. academic medical centers who were followed for 2 years after hysterectomy (Obstet Gynecol 2003;102:453). They found no statistically significant difference in rate of complication, length of hospital stay, or clinical outcomes specifically related to symptoms of bladder or bowel dysfunction and pelvic and back pain between the total and supracervical abdominal hysterectomy GYNECOLOGY Volume 61, Number 10 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACT Endometriosis is among the most important causes of chronic pelvic pain (CPP) in women of reproductive age; it reportedly is present in as many as one third of women having diagnostic laparoscopy for pain. This ...
The NSABP B-30 trial addresses whether amenorrhea after adjuvant chemotherapy increases survival. Preliminary to the trial outcome analysis, we examined the incidence of amenorrhea and its relationship to symptoms and quality of life (QOL) in the standard-care arm of this adjuvant HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript breast cancer trial. Premenopausal women treated on the doxorubicin-and-cyclophosphamidefollowed-by-docetaxel arm were included. Questionnaires assessing menstrual history, QOL, and symptoms were administered at baseline, day 1 of cycle 4 (or 9 weeks from start of chemotherapy for those who stopped chemotherapy early), and at 6, 12, and 24 months. Seven hundred and eight patients were evaluable for the analysis, with median potential follow-up of 57.5 months. Of these, 321 patients also participated in the QOL substudy. Of the 708 patients, 83% reported ≥1 episode of amenorrhea for ≥6 months. The estimated rate of resumption of menses at 24 months was 45.3% for women<40 years, 10.9% for women 40-50, and 3.2% for women >50 years. Those treated with tamoxifen were more likely to become amenorrheic (p = 0.003). Menstrual status was not significantly associated with QOL or symptoms. Prolonged amenorrhea is associated with a regimen that contains doxorubicin, cyclophosphamide, and docetaxel, and is age dependent and impacted by tamoxifen use. Vasomotor symptoms are common in this patient population but are not associated with menstrual status. These results can be used to inform premenopausal women about the risk and time course of amenorrhea associated with this common adjuvant therapy regimen, along with the effects on symptoms and QOL.
clinicaltrials.gov Identifier: NCT00003906.
Compliance in NSABP PRO studies is higher now than a decade ago. Results for compliance initiatives were mixed. Age and race are important factors, but institutional variation remains significant and largely unexplained.
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