Radical fertility preserving surgery of gynaecological malignancies – five-year-old file

Czech version

Authors: Michal Felsinger; Luboš Minář; Vít Weinberger; R. Hudeček
Authors‘ workplace: Gynekologicko-porodnická klinika LF MU a FN, Brno přednosta prof. MUDr. P. Ventruba, DrSc., MBA
Published in: Ceska Gynekol 2015; 80(5): 339-344

Overview

Objective:
Analysis of radical fertility preserving surgery, oncogynaecological treatment including their pregnancy effort.

Design:
Prospective study.

Setting:
Department of Obstetrics and Gynaecology, Masaryk University and Faculty Hospital Brno.

Methods:
The group of 13 patients in age fifteen to thirty-six, who underwent radical fertility preserving surgery of oncogynecological tumors (cervix, ovarium), 9 patients with ovarian cancer and 4 patients with carcinoma of cervix.

Results:
Histology showed seven times ovarial epithelial carcinoma, twice nonepithelial ovarial carcinoma, twice spinocelular cervical carcinoma, one adenosquamous and one lymfoepithelioma like carcinoma. We reported lymphocele as the most often postoperative complication by five patients with ovarial carcinoma, lymphoedema of lower limbs in one case and one of them complicated by bilateral hydronephrosis. After surgery procedures of cervical carcinoma, there was a stenosis of cervical canal with postoperative correction. In one case there was provided vaginal revision of cervix followed by embolisation of uterine arteries because of heavy bleeding in early postoperative period. After two years follow up, there are 12 patients in remission. There were four patients with fertlity plan, two with ovarial carcinoma, two with cervical carcinoma. The first group describes two pregnancies – one misscariage and one spontaneus labour in the date of delivery. There were 4 pregnancies in two patients wit cervical carcinoma. One patient has an intrapartal cesarean section because of scarring of the cervix after the operation. Next patients has two labours in due date, three labours in 34–37th week of pregnancy and one misscariage in 23 week of pregnancy. One patient has ovarial cancer during pregnancy, so the radical fertility preserving surgery was done after delivery.

Conclusion:
Methods and procedures of surgery with fertility preserving goals in our oncogynecological centre are in concordance with actual knowledge of medicine and respect oncological safety of patients with malignancies, who currently wish for fertility preserving treatment. Presented group of patients is relatively small, but results of oncological treatment and fertility plan demonstrate rightfulness of this tretament.

Keywords:
radical fertility preserving surgery, simple vaginal trachelectomy, adnexectomy, lymphadenectomy

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