Long-term results of organ sparing surgical treatments of precancerous cervical lesions / Монголын Анагаах Ухаан

ABSTRACT

Background: Cervical cancer is the most common cancer in female reproductive system. Since introduction of diagnostic modalities like Pap-tests, the detection pre-cancerous cervical lesions CIN1, CIN2 and CIN3 have increased dramatically. Early detection of pre-cancerous lesions enables performance of organ sparing treatments like LEEP, conization and cryotherapy.Aim: Since there are no studies in the field of organ sparing treatment of cervical cancer, we decided analyze the results of such treatments and calculate the1. Five year survival of patients underwent organ sparing surgical procedures2. Fertility and reproductive function of these patientsMethod: LEEP (n-63), knife conization (n-22) and trachelectomy (total removal of cervix) (n-15) was performed in women of reproductive age (25-35 years old) at National Cancer Center. The treatment results were followed for 5 years and statistical analysis of survival and reproductive function were analyzed.Results: 87.7% of patients with CINI lesions had LEEP, 12.3 % had knife conization and 0% had trachelectomy. 44.4% of patients with CINI lesions had LEEP, 55.6 % had knife conization and 0% had trachelectomies respectively. For CINIII 6.2% of patients had LEEP, 0% had knife conization and 93% had trachelectomy.We performed organ sparing treatment in 100 patients, out of which 10% had cancer recurrence in LEEP treatment, 9.1% in knife conization and 0% in trachelectomy. Complications of hemorrhage were observed in 14% of patients, cervical tube obstruction in 3% and deterioration of chronic inflammations in 13% respectively. After the organ sparing treatment, menstrual cycle was normal in 75% of the all patients, 65% reached pregnancy. 9.2% of patients who reached pregnancy had stillbirth, 12.3% had abortion, and 78.5% had normal delivery. 80.4% of patients with pregnancy had natural labors, while19.6% of patients had ceasarean sections respectively. Conclusion: in Mongolia, LEEP, knife conization and trachelectomy methods are used since 2000. But the treatment results were not reported so far. 10% of patients treated by LEEP and 9.1% of patients treated by knife conization had tumor recurrence. Thus our treatment efficiency is above 90%. Up to 20% of patients had complications ranging from bleeding to cervical tube obstruction. We conclude that organ sparing cancer treatment allows better QOL (quality of life) for the patients and provides opportunity to have children.