144\u2005Uterine transposition: clinical case report

Abstract

Objectives Conserving Therapy in cervical cancer has a wide range of surgical interventions from cone biopsy to different variants of radical trachelectomy. The accomplishment of radical trachelectomy in about 10% of all cases is not successful in conserving operating, owing to intraoperative findings of regional lymph nodes metastasis or inability to have intact resection edge. Meanwhile, some patients require adjuvant radioteraphy because of large size of primary cervical tumor. Methods We report a 23-year-old woman, with stage Ib2 cervical cancer. The patient had not had pregnancies so she insisted on preserving fertility. MRI tumor size was about 45x21x42mm and metastatic lesions were not detected. At the first step, three courses of taxanes and platinum-based chemotherapy were conducted, as well as GnRHa therapy to interrupt menses. The second step was a radical trachelectomy with uterus transposition, was held in 2018. The oncological stage of operation corresponded to a radical abdominal tracholectomy. Uterus blood supply was ensured by IP-ligaments, which are stood out about 15cm on each side. Due to this method, uterus and ovary mobility was achieved. It made uterus transposition paraumbilically possible so that created conditions for performing the radiotherapy. At the third step, the combined radiotherapy was provided according to standards. After three months a uterine reposition with utero-vaginal anastomosis was conducted. Results At present, our patient’s menses have been recovered. After six months of follow-up she has no sign of recurrence. Conclusions Uterine transposition is feasible after radical trachelectomy with preserve fertility. Undoubtedly, further studies of effectiveness and safety are required.