Radical trachelectomy for cervical cancer: Postoperative physical and emotional adjustment concerns

Objective. To investigate the incidence of cervical stenosis and related emotional and sexual adjustment concerns in women treated with radical trachelectomy. Methods. Prospective data of 30 stage I cervical cancer patients enrolled in an ongoing study were evaluated in combination with a medical chart review. Results. Eight patients (27%) did not have any stenosis of the neo-cervix postoperatively; 10 (33%) had clinically notable stenosis not requiring neo-cervical dilation to allow adequate sampling; moreover, 12 (40%,) had sufficient stenosis requiring a neo-cervical dilation procedure, which proved to be safe and useful. The majority of the dilation procedures (n=8) were conducted under local anesthesia in the office. At preoperative baseline survey, women reported a high rate of sexual inactivity. Fear of intercourse and dyspareunia were reported prior to surgery; however, trends of adjustment and improvement were noted over time postoperatively. Overall, fear of sexual activity tended to lessen if the degree of dyspareunia decreased over time. Postoperative dyspareunia decreased over time, which could have been associated with the mechanical stretching due to vaginal dilator use or dilating benefit of intercourse. Conclusion. Postoperative concerns associated with radical trachelectomy may be greater than what has been reported in the literature; however, several adjustment trends were noted with intermediate/long-term follow-up. Office cervical dilation is a simple procedure, which is helpful in the management of neo-cervical stenosis. We are currently investigating the value of a physician checklist as a clinical care model to remind medical professionals to monitor and address important survivorship issues. (C) 2008 Elsevier Inc. All rights reserved.