Jinekolojik Onkolojide Fertilite Koruyucu Cerrahi
Özet
Jinekolojik onkolojide fertilite koruyucu cerrahi, genç yaştaki kanser hastalarının üreme yeteneklerini ve hormonal fonksiyonlarını kaybetmeden tedavi edilmelerini amaçlayan multidisipliner bir yaklaşımdır. Erken evre serviks kanserinde, özellikle 40 yaş altı, tümör boyutu 2 cm'den küçük, FIGO evre IA1-IB1 arasındaki uygun histolojiye sahip hastalarda konizasyon veya radikal/basit trakelektomi güvenle uygulanabilmektedir. Endometrium kanserinde ise 45 yaş altı, myometrial invazyonu olmayan, FIGO grade 1 veya 2 endometrioid tip adenokarsinomlu hastalar progestin bazlı tedaviler (oral veya RİA) ve yakın endometrial takiple doğurganlıklarını koruyabilmektedir. Over tümörlerinde fertilite koruyucu yaklaşım, düşük grade'li ve tek overle sınırlı epitelyal kanserlerde unilateral salpingooferektomi ve evreleme cerrahisini içerirken; borderline over tümörlerinde oldukça güvenli sonuçlar vermekte ve kistektomi/ooferektomi ile başarılı şekilde yönetilmektedir. Malign germ hücreli over tümörleri ise kemoterapiye yüksek duyarlılıkları nedeniyle genç hastalarda fertilite koruyucu cerrahinin standart olarak uygulandığı ana gruptur. Tüm bu süreçlerde, hastaların onkolojik sağkalımından ödün vermeden en iyi obstetrik sonuçlara ulaşabilmesi için jinekolojik onkoloji, üreme endokrinolojisi ve infertilite uzmanlarının birlikte yer aldığı multidisipliner kurulların rolü ve hastalardan ayrıntılı onam alınması kritik önem taşımaktadır.
Fertility-sparing surgery in gynecologic oncology is a multidisciplinary approach aiming to treat young cancer patients without loss of reproductive capacities and hormonal functions. In early-stage cervical cancer, procedures like conization or radical/simple trachelectomy can be safely performed, particularly in patients under 40 with tumor sizes under 2 cm and specific histologies within FIGO stages IA1-IB1. For endometrial cancer, patients under 45 with verified FIGO grade 1 or 2 endometrioid adenocarcinoma limited to the endometrium can preserve fertility through progestin-based therapies (oral or IUD) combined with close endometrial sampling. In ovarian tumors, conservative management involves unilateral salpingo-oophorectomy and surgical staging for low-grade, single-ovary epithelial cancers, while it yields highly reliable outcomes in borderline tumors via cystectomy or oophorectomy. Malignant germ cell tumors represent the primary group where fertility-sparing surgery is considered the standard of care due to their excellent chemosensitivity. Throughout these processes, detailed patient consent and the involvement of multidisciplinary boards comprising gynecologic oncologists and reproductive endocrinologists are highly critical to achieve optimal obstetric outcomes without compromising overall oncological survival
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