Cervical Cancer, Lymphedema, Venous Thromboembolism
Conditions
Brief summary
Objective: To evaluate the impact of enhanced recovery after surgery (ERAS)-based nursing intervention on venous thromboembolism (VTE) and lymphedema after radical hysterectomy for cervical cancer. Methods: In this prospective randomized controlled trial, 160 patients scheduled for radical hysterectomy during September 2022-September 2024 were randomized to an ERAS group (n = 80) or a control group (n = 80). The control group received conventional perioperative care, while the ERAS group received a multimodal perioperative care protocol. Primary outcomes were the 6-month incidence of VTE and lower limb lymphedema. Secondary outcomes included recovery indicators, inflammatory and coagulation markers, quality of life \[QoL; assessed by the Quality of Life Questionnaire-Core 30 (QLQ-C30)\], and nursing satisfaction.
Interventions
BEHAVIORALERAS group
In addition to conventional care, the ERAS group received a comprehensive intervention protocol based on ERAS principles, implemented by a dedicated ERAS nursing team. Details are as follows: Preoperative interventions: (1) Enhanced education and prehabilitation: Detailed explanation of the ERAS pathway, VTE and lymphedema prevention using graphics and videos. Instruction on ankle pump exercises and quadriceps isometric contractions. (2) Nutritional support: Nutritional risk assessment and provision of oral nutritional supplements if necessary. (3) Fasting management: No solid food for 6 hours, clear oral fluids (e.g., 200 mL of 10% glucose solution) allowed up to 2 hours preoperatively. Intraoperative interventions: (1) Thermoregulation: Use of forced-air warming blankets and fluid warmers to maintain core temperature \> 36°C. (2) Restrictive fluid management: Goal-directed fluid therapy to avoid excessive infusion. (3) Minimally invasive and meticulous surgery: Encouragement of laparo
Sponsors
People's Hospital of Xinjiang Uygur Autonomous Region
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* . Pathologically confirmed cervical cancer (FIGO 2018) 2. Age 18-70 years 3. First-time radical hysterectomy 4. ASA physical status class I-II 5. Perioperative anticoagulant prophylaxis per hospital standards 6. Provision of informed consent
Exclusion criteria
* 1\. Pre-existing lower extremity DVT, lymphedema, or severe varicose veins 2. Severe cardiac, hepatic, or renal dysfunction or coagulation disorders 3. History of psychiatric illness or communication barriers 4. Pregnant or lactating women
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Postoperative Venous Thromboembolism (VTE) | 6 months after surgery | Composite incidence of deep vein thrombosis (DVT) of the lower extremities and pulmonary embolism (PE). DVT is diagnosed by bilateral lower extremity venous color Doppler ultrasonography performed on postoperative day 3, before discharge, and at 1, 3, and 6 months postoperatively or when clinically indicated. PE is evaluated by computed tomography pulmonary angiography (CTPA) when clinically suspected. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of Postoperative Lower Limb Lymphedema | 6 months after surgery | Diagnosis based on International Society of Lymphology criteria (Grade I: pitting edema relieved by elevation; Grade II: non-pitting edema with tissue fibrosis; Grade III: elephantiasis). Measured by bilateral calf circumference (thickest point) and thigh circumference (15 cm above patella). |
| Time to First Flatus | Within 14 days after surgery (typically hours to days) | Number of hours from surgery completion to first passage of flatus, indicating recovery of gastrointestinal function. |
| Time to First Defecation | Within 14 days after surgery (typically days) | Number of hours from surgery completion to first bowel movement. |
| Time to First Ambulation | Within 7 days after surgery | Number of days from surgery completion to the first time the patient walks independently (assisted or unassisted) outside the bed area. |
| Postoperative Length of Hospital Stay | At hospital discharge, assessed up to 4 weeks postoperatively | Total number of days from the date of surgery to the date of hospital discharge. |
| Change in C-Reactive Protein (CRP) | Preoperative (baseline) vs. Postoperative day 3 | Change in serum C-reactive protein (CRP) measured from fasting blood samples, reported in mg/L. |
| Change in D-Dimer (D-D) | Preoperative (baseline) vs. Postoperative day 3 | Change in plasma D-dimer (D-D) measured from fasting blood samples, reported in mg/L. |
| Change in Platelet Count (PLT) | Preoperative (baseline) vs. Postoperative day 3 | Change in platelet count (PLT) measured from complete blood count, reported in ×10⁹/L. |
| Change in Global Health Status / Quality of Life (QLQ-C30) | Preoperative (baseline) vs. 6 months postoperatively | Change in the Global Health Status / Quality of Life subscale score from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Minimum value: 0. Maximum value: 100. Higher scores indicate better quality of life. |
| Nursing Satisfaction | At hospital discharge (postoperative day 7 to day 15) | Measured by the Newcastle Satisfaction with Nursing Scale (NSNS). Categorized as: highly satisfied, moderately satisfied, or not satisfied. Overall satisfaction rate = (highly satisfied + moderately satisfied) / total patients × 100%. |
| Change in White Blood Cell Count (WBC) | Preoperative (baseline) vs. Postoperative day 3 | Change in white blood cell count (WBC) measured from fasting blood samples, reported in ×10⁹/L. |
| Change in Prothrombin Time (PT) | Preoperative (baseline) vs. Postoperative day 3 | Change in prothrombin time (PT) measured from fasting blood samples, reported in seconds. |
| Change in Hemoglobin (Hb) | Preoperative (baseline) vs. Postoperative day 3 | Change in hemoglobin (Hb) measured from complete blood count, reported in g/L. |
| Change in Functional Scales (QLQ-C30) | Preoperative (baseline) vs. 6 months postoperatively | Change in the Functional Scales composite score from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Minimum value: 0. Maximum value: 100. Higher scores indicate better functional status. |
| Change in Symptom Scales (QLQ-C30) | Preoperative (baseline) vs. 6 months postoperatively | Change in the Symptom Scales composite score from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Minimum value: 0. Maximum value: 100. Higher scores indicate worse symptom burden. |
| Change in Single Items (QLQ-C30) | Preoperative (baseline) vs. 6 months postoperatively | Change in the Single Items score (including dyspnea, insomnia, appetite loss, constipation, diarrhea, financial difficulties) from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Minimum value: 0. Maximum value: 100. Higher scores indicate worse symptom burden or greater financial difficulty. |
| Change in Total Score (QLQ-C30) | Preoperative (baseline) vs. 6 months postoperatively | Change in the total score from the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Minimum value: 0. Maximum value: 100. Higher scores indicate better overall quality of life. |
Countries
China
Outcome results
None listed