MD Anderson Cancer Center Madrid pioneers in Spain surgery on a 12-year-old girl affected with cancer of the cervix-vagina without affecting her fertility

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November 20, 2017
  • The low incidence of this type of tumors, together with the difficulty of performing a radical laparoscopic trachelectomy, explains the importance of this unique surgical intervention in Spain.
  • Dr. Javier de Santiago, head of the Gynecologic Oncology Service at MD Anderson Cancer Center Madrid led the team carrying out the intervention.

Dr. Javier de Santiago, head of the Gynecolgic Oncology Service at MD Anderson Madrid, has successfully removed a cervical-vagina cancer laparoscopically from a girl as young as 12 years old without compromising her fertility. It is the first time that an intervention of this kind has been carried out in our country on such a small girl. "It is a very special case due to the low incidence of this type of rare tumors, which appear very punctually in scientific literature, as well as the difficulty of the technique used", said Dr. de Santiago.

The intervention, which took place this September and lasted about three and a half hours, consisted of performing a radical trachelectomy, that is, the removal of part of the cervix and surrounding tissue, followed by a colpectomy of the upper third (or vaginal vault), that is, the removal of the upper part of the vagina. In addition, during the procedure, the pelvic nodes were removed and analyzed using the sentinel lymph node technique, which consists of evaluating the first lymph nodes of the cervix with the aim of knowing the extent of the disease.

"During the intervention, we collected a sample and sent it to our colleagues in the Pathological Anatomy Service, who are in charge of telling us whether the lymph nodes are positive or negative," says Dr. de Santiago. "If the lymph nodes are negative, we can continue with the intervention and try to preserve fertility; If there is disease in the lymph nodes, we stop the intervention, because, in that case, the patient should receive prior treatment with chemotherapy and/or radiotherapy before considering surgical intervention” continues the head of the Gynecologic Oncology Service at MD Anderson Madrid, who explains that the lymph nodes in this patient were negative, which allowed them to continue with this pioneering intervention.

After the extirpation, the genital tract was reconstructed during the same surgery, joining the cervix to the patient's vagina. Both the excision and the subsequent reconstruction were done laparoscopically, a much less invasive technique than open surgery and which, says Dr. de Santiago, "allows a much faster recovery and less postoperative pain."

Preservation of fertility

The usual technique in this type of gynecological tumors is the removal of both the uterus and the cervix, which implies that the patient loses her reproductive capacity. But, as Dr. de Santiago points out, "in women who have not had children or who are considering having children in the future, it is important to try to perform this type of less invasive interventions, that can preserve future fertility."

In the opinion of this specialist, "these types of techniques are equally safe oncologically, but allow fertility to be preserved as they require the removal of only a part of the cervix maintaining between 0.5 and 1.5 cm, and preserving both the uterus and the fallopian tubes of the patient".