conservative treatment is extremely negative. Besides, most young women in this group suffer from
depressions of different severity, stress and sexual dysfunction due to unrealized reproductive function [7, 8, 9,
10].
The characteristics of CC morphogenesis and carcinogenesis, high survival rates at early stages of the
disease and an increase in the number of reproductive-age patients in Uzbekistan are motivating
oncogynecologists to improve the quality of life for CC young women by retaining their fertility. It necessitates
further development and implementation of organ-preserving surgery, i.e. abdominal radical trachelectomy
(ART).
Cervical cancer is mainly characterized by the local spread of the neoplastic process. Most often the
tumor involves the upper part of the vagina, parametral tissue and sacro-uterine ligaments. As our experience
shows, the tumor spreading to the upper parts of the uterine is observed less often (13-15%). In 28-34% of
patients, the tumor is localized in the lower part of the cervical channel, in 15% it develops in the middle part of
the cervix and in 2% - in its upper part. The middle and lower thirds of the vagina are affected at later CC stages
and were seldom observed.
CC metastasis development depends on the histological structure of the tumor. According to the findings
of different researchers, in squamous cell CC, metastases incidence to the ovaries varies from 0.2% to 2.2%,
while in adenocarcinoma it reaches 2-10%. The necessity of ovaries resection is disputable because the risk of
metastasis development in this period is not high. Lymphogenic metastases in CC involve parametral,
obturator, iliac, sacral, presacral, lateral and aortal lymph nodes. The most significant CC predicting factors
influencing selection of treatment tactics are tumor size, invasion depth, parametral tissue infiltration,
metastases in regional lymph nodes.
Objective of the research: was to develop an organ-preserving surgical technique resulting in
improvement of quality of life for young CC patients through better management of the surgical field.
MATERIAL AND METHODS
Traditionally radical abdominal trachelectomy (ART) consists of total or partial resection of the uterine
cervix, upper third part of the vagina, the tissue around the uterine cervix and vagina, uterovesical, sacrouterine
and cardinal ligaments as well as general common, internal and external ileac vessels. The fertility-sparing ART
modification developed by us enables to perform total or partial resection of the affected part of the uterine
cervix after total mobilization of the cervix and excision of the upper and middle parts of the vagina. The
modification provides better management of the surgical field that helps avoid accidental intra-operative
injuries of the nearby organs and tissues.
In the Gynecology department of the NCRC of the Uzbekistan MoH, 204 modified fertility-sparing ARTs
have been performed for CC women of reproductive age (27 to 37 years) at the early stage of the disease (T1A,
T1B). The research was conducted in 2012-2015.
The eligible patients were examined clinically and instrumentally. The carefully collected history of the
patients included the information on their genital and extragenital diseases and conditions. The objective
gynecological examination determined the tumor type, spread of cervical tumor to loco-regional lymph nodes,
condition of vaginal walls and parametral tissue. Histological investigation of the tissue samples taken from the
affected area showed that most of 207 women involved in the study had squamous cell cervical cancer: 89 of
them had non-keratinizing squamous cancer; 189 patients had keratinizing squamous cell cancer, and 7 ones
had adenocarcinoma.
Abdominal radical trachelectomy includes partial or total hysterectomy, resection of the upper third of
the vagina, pelvic tissue around the cervix and vagina, the vesico-uterine, sacro-uterine and cardinal ligaments,
and the common, internal and external iliac vessels. ART is known to differ from radical hysterectomy with
resection of the appendages; it not only preserves the uterus, ovaries and fallopian tubes, but the patient’s
reproductive function as well.
Ethical approval
The written informed consent was obtained from each patient involved in the research. The review board
and ethics committee of National Center for Cancer Research under the MoH Tashkent, Uzbekistan.approved
the study protocol.
To cite this paper: Navruzova V.S. 2018. Modified Radical Abdominal Trachelectomy in Cervical Cancer in Young Women. J. Life Sci. Biomed. 8(1): 19-
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