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Trachelectomy

Trachelectomy at a glance

  • Trachelectomy is the surgical removal of a woman’s uterine cervix and part of her vagina.
  • The procedure aims to preserve fertility in women with cervical cancer by removing the cervical tumor while keeping the uterus intact.
  • Patients for this procedure must be women of childbearing age with early cancer confined to their cervix.
  • Fertility preservation is not guaranteed after trachelectomy, and the procedure increases the risk of miscarriage in women who do become pregnant.
  • Delivery of a baby after removal of the cervix must occur via cesarean section.

What is trachelectomy?

Trachelectomy, also known as cervicectomy or radical cervix removal, is the surgical removal of a woman’s cervix and the upper part of her vagina because of cervical cancer. The cervix is the lower part of the uterus and connects the vagina to the uterine body. Unlike hysterectomy, which includes the removal of all or part of a woman’s uterus, trachelectomy leaves the body of the uterus intact. If cancer cells are found at the edge of the removed cervical tissue, a hysterectomy may still be necessary to make sure that all cancer cells are removed.

Trachelectomy is used to preserve fertility in women under the age of 40 who are diagnosed with early-stage cervical cancer (stage I or IIa). This procedure is not recommended in women with late-stage or wide-spread cancer.

Cervical cancer is the second most common malignancy in women worldwide. It can be discovered during its early stages using a Pap test, an exam that evaluates the cells of the cervix for abnormal changes that may lead to cancer. Most cervical cancer is caused by human papillomavirus, or HPV, which can be contracted via sexual contact with someone who has the virus.

Trachelectomy procedure and methods

During a trachelectomy, the surgeon places a stitch called a cerclage at the bottom of the uterus that acts as an artificial opening (or a drawstring) in the uterine cavity to allow the flow of menstrual blood. In some cases a catheter may be put temporarily in place to keep this opening from immediately closing. The stitch functions as the cervix so that, in certain women, pregnancy may still occur.

If the cervical cancer is caught in an early stage, surgeons perform one of the following two methods for trachelectomy. The method used is based on patient anatomy and the current development of the cancer.

Radical abdominal trachelectomy

The surgeon makes an incision across the woman’s stomach. Her cervix, the tissue surrounding her cervix, part of her vagina and her pelvic lymph nodes are removed. Research showed that patients who underwent radical abdominal trachelectomy obtained more favorable oncology results than those who underwent vaginal trachelectomy, but saw slightly less favorable fertility outcomes.

Radical vaginal trachelectomy

This procedure is performed either vaginally or laparoscopically through three or four small incisions in the stomach. Laparoscopy is a minimally invasive surgery that often allows for shorter recovery times due to smaller incisions. The laparoscope, a telescope-like instrument, enables doctors to view and operate on the area from a more distant, but more accessible, location.

During radical vaginal trachelectomy, the cervix, part of the vagina and the pelvic lymph nodes are removed. A survey of medical literature in 2007 found that after this procedure, 70 percent of patients who wanted children could conceive, but their risk of miscarriage was notably higher than that of healthy women.

Who should consider trachelectomy?

To undergo trachelectomy, a woman must be in the early stage of cervical cancer, with a tumor size equal to or less than 2 centimeters that is confined to her cervix. She should be of childbearing age – younger than 40 years old – with a desire to preserve her fertility. 

Risks and side effects of trachelectomy

The trachelectomy procedure involves short-term risks, which may include:

  • Painful sexual intercourse
  • Bladder and urination problems
  • Vaginal discharge
  • Infection
  • Bleeding
  • Deep vein thrombosis, or swelling of the legs
  • Adverse reactions to anesthesia, including nausea/vomiting, dizziness, headache and lung infection

In rare cases, the procedure may cause a hole in the bladder or ureter, which may either heal on its own or require additional surgery.

Some women can experience long-term effects from the procedure, which may include:

  • Lymphedema – swelling that occurs when lymph fluid cannot flow normally due to the removal of lymph nodes
  • Stress incontinence – involuntary urine leakage when pressure is increased in the abdomen

Unfortunately, trachelectomy cannot guarantee fertility preservation for every patient. If a woman does become pregnant after the procedure, there is an increased risk of early delivery.

Additionally, if pregnancy occurs, the baby must be delivered via cesarean section, since the woman will no longer have a cervical opening.