08 ian. LAPAROSCOPIC PELVIC LYMPHADENECTOMYWITH VAGINAL RADICALTRACHELECTOMY IN A NULLIPAROUS PATIENTWITH EARLY STAGE CERVICAL CANCER– CASE REPORT
L. Pirtea1, Cristina Secosan1,, G. Crãciun2, Lavinia Bãlan2, Gina Baltã2, Porfira Bostinã2, Ligia Bãlulescu2, D. Grigoras1
1 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
2 Department of Obstetrics and Gynecology, County Hospital Timisoara, Romania
Abstract
Radical trachelectomy is considered standard of care in patients with early-stage cervical cancer interested in future fertility. Fertility-sparing radical trachelectomy appears to have similar surgical and oncologic outcomes to more extensive radical procedures in selected patients with early stage cervical cancer. Tumors of 2 cm or less are considered to have a lower risk of parametrial involvement, a more favorable 5-year overall survival rate and a better fertility outcome. Nevertheless, pregnancies after trachelectomy should be considered as high risk. The procedure requires advanced vaginal surgical skills when performed in nulliparous women. We present a case of laparoscopic pelvic lymphadenectomy with vaginal radical trachelectomy performed in our clinic on a nulliparous patient diagnosed with FIGO stage IA1 cervical cancer, who desired to preserve her fertility. Sentinel node mapping using methylene blue and cerclage placement at the end of the procedure were also performed.
Rezumat
Trachelectomia radicalã este consideratã tratamentul standard pentru pacientele cu cancer de col uterin în fazã incipientã care doresc sã îi pãstreze fertilitatea. Conservarea fertilitãtii prin aceasta procedurã chirurgicalã nu pare sã pericliteze rezultatele oncologice în cazuri selectate cu cancer cervical incipient. Tumorile de 2 cm sau mai putin sunt considerate a avea un risc scãzut de invazie parametrialã, o supravietuire globalã la 5 ani mai favorabilã si rezultate mai bune din punct de vedere al fertilitãtii. Cu totate acestea, sarcinile obtinute dupã trachelectomie radicalã trebuie considerate ca fiind cu risc crescut. Trachelectomia radicalã vaginalã necesitã abilitãti chirurgicale vaginale avansate atunci când este efectuatã la nulipare. Prezentãm un caz de limfadenectomie pelvinã cu trachelectomie radicalã efectuat în clinica noastrã la o pacientã nuliparã diagnosticatã cu cancer de col uterin stadiul FIGO IA1, care dorea conservarea fertilitãtii. În timpul interventiei chirurgicale s-au efectuat de asemenea identificarea ganglionului santinelã folosind albastru de metilen si aplicarea unui cerclaj la finalul procedurii.
Cuvinte cheie: trachelectomie radicalã, chirurgie, cancer de col uterin, limfadenectomie, laparoscopie, cerclaj, nuliparã.
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