358 The case of cervical cancer IB3 with mielotoxity after 2 cycle of chemotadiotherapy treated with radical hysterectomy as the last method of choice

Introduction/Background* Patients with stage IB3 cervical cancer are usually qualified for radiochemotherapy. However, sometimes ther is a high toxicity of this treatment, which lead us to look for non-standard soltions. Nevertheless, we know that a combination of radical surgery, radiotherapy and chemotherapy is also burdened with a high toxicity. Methodology Radical hysterectomy type C Querleu-Morrow and pelvic and para-aortic lymphadenectomy was performed with laparoscopy – as a minimally invasive procedure. Result(s)* The case of a 27 year old lady with cervical cancer FIGO IB3 is qualified for chemoradiotherapy (Histopathology: Cervical adenocarcinoma G2). She had received 28 f Grey and one cycle of cisplatin (70 mg).The treatment was postponed because of huge myelotoxicity. As no other choice, she was qualified for radical hysterectomy type C Querleu-Morrow and pelvic – para-aortic lymphadenectomy. Radical hysterectomy was performed with laparoscopy – as a minimally invasive procedure that is less traumating for depressing immune system. Postoperative histopathology: cervix -chronic inflammation. There were observed no neoplastic changes in the uterus, fallopian tubes, ovaries, pelvic and para-aortic lymph nodes. One month after surgery there was observed massive vaginal fistula, massive inflamatory changes were visible in cystoscopy. Two months after surgery -bilateral hydronephrosis, both in double J ureteral stent were inserted. 5 months after surgery no hydronephrosis was detected, both double J stents from the ureters were removed. Next there were observed episodes of high urosepsis with bilateral hydronephrosis, finally 7 months after surgery – double J stends to both ureters were necessary. Conclusion* We are conscious that finally, retransplantation of the ureters is necessary otherwise the patient will be obliged to continuous exchange of the double J stands in both ureters and the episodes of the urosepsis would reply – but if the urologic surgery is needed it could be done not earlier than one year after radiotherapy. Patient is without the recurrence for 12 months but we know that any chemotherapy or radiotherapy will cause the huge toxicity that is why she is only under observation. We tried to balance the benefits from the radicality and the minimally invasive surgery at this particular patient.