Tailored surgical therapy in young patients in cervcial cancer - saving reproductive function
Aleksandar Stefanovic (RS)
[Stefanovic] Clinic for Gynecology and Obstetrics Clinical Center of Serbia, Medical School University of Belgrade
Fertility-preserving surgery in early cervical cancer is option for small disease, it includes conization , radical trachelectomy , or ovarian transposition. Trachelectomy is a conservative operation aiming to preserve fertility in early stages of cervical cancer in young female that have realized reproduction. Excised structures in trachelectomy are: cervix, upper 1/3 of vagina, parametria and paracolpia, with preservation of uterine corpus. After removing the vaginal fornix and cervix , uterovaginal anastomosis with non resorptive suture is performed.. Whenever technically possible and in selected patients preservation of both asscending and descending uterine vessels was done. Indications are, patients up to 45 years of age who desire to conserve fertility with negative lymph nodes, no distant metastatic disease , FIGO staged IA1, IA2, IB1 -tumour size ≤ 2cm with negative lymph nodes, with adequate cervical length, no evidence of expansion of malignat proces ,squamocellular carcinoma,cervical adenocarcinoma, negative lymph nodes intraoperatively, no metastatic disease, clear resected margins Simple trachelectomy is performed in parametrial involvement rate < 1% in patients with IB1 ≤ 2cm, and stromal invasion ≤ 10mm. Systematic review of the literature showed obstetrical outcomes after abdominal radical trachelectomy , with 438 trachelectomy performed, who achieved 75 pregnancies, resulted in 45 deliveries.