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Traquelectomia como método de preservação da fertilidade no carcinoma do colo do útero
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Advisor(s)
Abstract(s)
A implementação dos programas de rastreio tem conduzido à redução da incidência do carcinoma do colo do útero e à sua
detecção em estádios mais precoces. Contudo, esta continua a ser uma patologia frequente, nomeadamente em Portugal, constituindo
a neoplasia maligna ginecológica mais frequente no grupo etário abaixo dos 50 anos e levantando a premente questão da preservação
da fertilidade. A Traquelectomia radical é uma técnica cirúrgica recente, já realizada em Portugal e exequível nos casos de
tumor invasivo em fase precoce (estádio IB1). Consiste na remoção do colo do útero, de um segmento proximal contíguo dos
paramétrios e da cúpula vaginal, associado a um procedimento de linfadenectomia pélvica, sendo realizada uma anastomose
corpo ou istmo-vaginal que permite a manutenção da fertilidade. Em termos de prognóstico e taxa de recidiva, a literatura não
mostra diferenças significativas face à histerectomia radical. Cabe ao radiologista um contributo importante no correcto
estadiamento, sobretudo quanto à extensão local da doença, para adequada decisão terapêutica e selecção das doentes jovens com
desejo de preservação da fertilidade que irão beneficiar da realização de traquelectomia.
The implemented screening programs have been responsible for a reduction in the cervical cancer incidence and detection in earlier stages. However, it is still a prevalent disease, particularly in Portugal and represents the most frequent gynecologic malignancy in women with less than 50 years of age, what raises the fertility problematic. Radical Trachelectomy is a recent option, just beginning to be performed in Portugal, which can be performed in the IB1 stage (early invasive cancer). It consists in removal of the cervix, its contiguous parametrium and vaginal cuff, in addition to a pelvic lymphadenectomy, with a vaginoisthmic anastomosis allowing fertility preservation. In terms of prognosis and recurrence rate, this operative technique is comparable to radical hysterectomy in literature review data. An important contribute concerning the accurate stage assessment relies on the Radiologist, particularly in relation to local tumor extent, to determine the best therapeutic option and correctly select the young patients that desire to preserve their fertility.
The implemented screening programs have been responsible for a reduction in the cervical cancer incidence and detection in earlier stages. However, it is still a prevalent disease, particularly in Portugal and represents the most frequent gynecologic malignancy in women with less than 50 years of age, what raises the fertility problematic. Radical Trachelectomy is a recent option, just beginning to be performed in Portugal, which can be performed in the IB1 stage (early invasive cancer). It consists in removal of the cervix, its contiguous parametrium and vaginal cuff, in addition to a pelvic lymphadenectomy, with a vaginoisthmic anastomosis allowing fertility preservation. In terms of prognosis and recurrence rate, this operative technique is comparable to radical hysterectomy in literature review data. An important contribute concerning the accurate stage assessment relies on the Radiologist, particularly in relation to local tumor extent, to determine the best therapeutic option and correctly select the young patients that desire to preserve their fertility.
Description
Keywords
Traquelectomia Carcinoma Colo Fertilidade Trachelectomy Carcinoma Cervix Fertility
Citation
Cecília Leal; Teresa Margarida Cunha; Ana Francisca Jorge. Trachelectomy as a Method of Fertility Preservation for Cervical Cancer, Acta Radiológica Portuguesa, 88, 33-37, 2010.