P100 Long term obstetric outcomes after less radical fertility sparing treatment in patiens with small volume stage i cervical cancer
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Abstract:
Introduction/Background
The purpose of the study is to present our clinical experience, pregnancy management and long term obstetrical outcome after less radical fertility sparing surgery SLNM + laparoscopic lymphadenectomy + simple trachelectomy or large recone.Methodology
From 1999–2018, 91 women with squamous or adenocarcinoma with tumor less than 20 mm in the largest diameter and infiltration less than half of cervical stroma underwent laparoscopic SLNI and select extirpation of afferent parametrial channel and frozen section (FS) of SLN and laparoscopic pelvic lymphadenectomy or only SLN. Second step is simple trachelectomy without cerclage or large recone.Results
Fertility was definitely spared in 76 women. 3 women (3.3%) not plan pregnancy, 9 currently plan pregnancy in future (9.9%), 64 women (84.2%) wish to be pregnant and 53 was pregnant (82.8%). From 76 fertility spared, 53 was pregnant - pregnancy rate 69.7%, 44 women have 50 baby - delivery rate was 57.9%. 37 was term pregnancy (74%), extreme premature 24–27w - 2 baby (4%), premature (28–32w) - 2 baby (4%), premature (33–37w) - 9 baby (18%). 22 unsuccessful pregnancy (5 artericial abortion, 11 spontaneus abortion in 1 trimestr, 4 spontaneus abortion in 2 trimestr, 2 GEU. Two women after hysterectomy have two baby with donor mother.Conclusion
SLNM and laparoscopic pelvic lymphadenectomy with simple trachelectomy or large recone in small volume cervical cancer (less than 2cm in the largest diameter and less than half of stromal invasion) have excellent pregnancy result. This work was supported by Charles University research program PROGRES Q 28 (Oncology).Disclosure
Nothing to disclose.Keywords:
Trachelectomy
Lymphadenectomy
Cervical cancer is the third most common female cancer worldwide and the use of routine screening resulted in earlier stage and younger age at diagnosis. Fertility preservation via radical trachelectomy comes up as an option in such patients. Recent literature reviews confirm the safety of this operation with excellent oncologic outcomes in appropriately chosen patients. However, recurrent disease is likely and a strict follow-up is recommended to detect recurrences at an early stage following radical trachelectomy. In this report, a case who underwent radical trachelectomy and developed widespread recurrences 7 years after initial surgery possibly due to the lack of oncologic follow-up is discussed.
Trachelectomy
Radical surgery
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In recent years,the incidence of cervical cancer has the trend to ascend,with the age of patients getting younger.The young patients with cervical cancer need to preserve their fertility sparing.With the development of the new surgery and Laparoscopic,radical trachelectomy surgery,radical trachelectomy surgery as a new method of the treatment of early cervical cancer,restrictedly controls its surgical indications,and in combination with medical ethics and principles of evidence-based medicine,radical trachelectomy surgery not only achieves a radical cure of cervical cancer,but also fully takes into consideration the fertility sparing of the young patients with cervical cancer.Therefore,cervical radical trachelectomy is a feasible,effective and reasonable surgery.
Trachelectomy
Radical surgery
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For all patients affected by a disease that could impair fertility before or during the reproductive lifespan, strategies to preserve their fertility and the ability to bear their own children is likely to be of utmost importance. While fertility preservation is a promising option, most of the technologies currently used are far from being well-established or are still experimental. Patients should be aware that no method guarantees success. Psychological and ethical impacts of fertility preservation are major concerns and should be included in the multidisciplinary approach to the patients.
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Trachelectomy
Parametrial
Cervical conization
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Cervical cancer is world-wide the second most frequent cancer found in women and represents 12% of all female malignancies. In fact, it is the most common female cancer in developing countries. There is now sufficient evidence to recommend that women with locally advanced cervical cancer confined to the pelvis receive concurrent pelvic radiation and chemotherapy. New surgical techniques such as laparoscopically assisted radical vaginal hysterectomy and trachelectomy (a fertility-preserving radical operation technique) are being established and have to be evaluated for their long-term safety. Causal treatment by developing multivalent antiviral drugs and vaccines is no longer a pure theoretical approach. Despite these improvements, the early diagnosis by colposcopy and gynaecological cytology remains the safest method to ensure early treatment avoiding death of cervical cancer.
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Vaginal cancer
Gynecologic cancer
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Trachelectomy
Lymphadenectomy
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