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66 Radical trachelectomy. Experience in KaIOR
  1. A Satanova1,
  2. D Kaidarova2,
  3. Y Kukubassov1,
  4. R Bolatbekova3 and
  5. D Kaldybekov1
  1. 1Kazakh Institute of Oncology and Radiology, Oncogynecology, Almaty, Kazakhstan
  2. 2Kazakh Institute of Oncology and Radiology, Head of Institute, Almaty, Kazakhstan
  3. 3Almaty Oncological Center, Oncogynecology, Almaty, Kazakhstan


Introduction/Background*Radical trachelectomy with pelvic lymphadenectomy, originally described by Dargent et al. in 1988 became a new treatment option for young patients in the world with early invasive cervical cancer who want to maintain their fertility. Recent data indicate that cancer outcomes after radiation therapy are comparable to those after standard radical hysterectomy .Fertility-sparing radical trachelectomy was revolutionary when it first appeared. This procedure now allows patients to survive cancer and save uterus for future bearing of the child. Initially, they approached him as a vaginal procedure with laparoscopic evaluation. This approach is comparable to type B or modified radical hysterectomy, but with greater limited resection of parametrium.

Result(s)*Since 2013, radical trachelectomy has been performed at KazIOR. From 2013 to 2021, 8 operations were performed, 7 of them by abdominal access, 3 by laparoscopic approach. 6 (75%) of the patients had stage 1 in 1 from 2 to 4 cm; 2 (25%) had a 1a1 stage. No patient had a tumor larger than 4 cm on examination, MRI, and histological examination. No patient received neoadjuvant chemotherapy. 2 patients (25%) underwent a biopsy for the purpose of establishing a diagnosis, 6 patients (75%) conization of the cervix. The average age of the patients was 28 years (from 26 to 37 years). 5 (62.5%) patients were nulliparous, 2 patients had 2 children, 1 patient had 1 child.

LVSI was negative in preoperative histological examination, and resection margins were also negative. In 1 patient (12.5%) after histological examination LVSI was positive, in 7 it was negative. Of the 8 patients who retained fertility, there were 5 pregnancies, 2 miscarriages at 9–10 weeks, and 3 deliveries at 36–37 weeks of gestation.

Conclusion*Thus, in 2013–2021, 8 radical trachelectomy operations were successfully performed. The data presented in this publication demonstrate that patients with stage IB1 tumors ranging in size from 2 to 4 cm and with favorable histology are acceptable candidates for attempted radical trachelectomy. These patients must be clearly informed of all the options if they want to consider maintaining fertility.

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