Laparoscopic radical vaginal-assisted trachelectomy in invasive cervical cancer treatment
AbstractThe aim of the study was to evaluate results of laparoscopic radical vaginal-assisted trachellectomy (LRVAT) in patients with invasive cervical cancer.
Material and methods. Invasive cervical cancer organ preservation treatment in form of LRVAT was performed between October 2014 to June 2017 in P.A. Hertsen Moscow Scientific and Research Oncological Institute for 32 patients at the age of 23-41 years. The essence of the operation consisted in combination of laparoscopic approach that was made to perform pelvic lymphadenectomy, parametriums and uterosacral ligaments resection, uterine arteries transsection with subsequent cervix uteri ablation anduterovaginal anastomosis formation (through transvaginal approach).
Results. Average operation time was 220±29 min, average blood loss was 180+76 ml. Complications that required surgical correction or had an impact on case management tactics were not recorded. In 4 (12.5%) cases (according to histological studies results) hysterectomy with ovarian transposition was performed, adjuvant radiation therapy was assigned to 1 (3.1%) patient. Reproductive potential was preserved in 87.5% of patients. With a median follow-up of 27 months continued tumor growth in cervical stump was noted in 1 patient, and 2 patients became pregnant.
Conclusions. Combined approach in radical trachelectomy allows to combine operation radicalism with all advantages of minimally invasive and transvaginal surgery. Promising trend for research is neoadjuvant chemotherapy for tumors >2 cm in diameter followed by LRVAT. For end-to-end and objective assessment of offered methodology results further accumulation and analysis of clinical material is required.
Keywords:invasive cervical cancer, organ preservation treatment, radical trachelectomy
Obstetrics and Gynecology: News, Opinions, Training. 2018; (1): 44-50. DOI: 10.24411/2303-9698-2018-00005