- What is a trachelectomy?
- Other surgeries
- Non-surgical alternatives
- Trachelectomy and fertility
- Trachelectomy procedures
- Risks & Side-effects
What is a trachelectomy?
A trachelectomy, sometimes called a cervicectomy, is a surgical procedure used to treat early-stage cervical cancer. The definition of a radical trachelectomy – the most common form of this procedure – is the removal of the cervix and part of the vagina. The ovaries and the uterus are left in place, with the uterus connected to the vagina by an artificial band. The doctor may also remove the lymph nodes near the cervix. A simple trachelectomy, which is less often performed, removes only the cervix.
Trachelectomy compared to other surgeries
A trachelectomy is one of several common surgical procedures used to treat cervical cancer. The method selected depends on multiple factors, including a woman’s age, desire to maintain fertility and the cancer’s stage of development. Non-surgical treatments include radiation and chemotherapy, both of which include a risk of possible side-effects.
Trachelectomy vs. hysterectomy
A trachelectomy is an alternative to a hysterectomy, which removes both the uterine body and the cervix. In some cases, a hysterectomy will also remove the fallopian tubes, ovaries, some surrounding tissue, the nearby lymph nodes or part of the vaginal canal. A person cannot become pregnant following a hysterectomy. While a hysterectomy is the most common surgical procedure used to treat cervical cancer, a trachelectomy may be more appropriate in the early stages of the cancer, as it is able to preserve a person’s fertility.
Trachelectomy vs. conization (cone biopsy)
Both of these procedures can help treat early-stage cervical cancer, but a radical trachelectomy is more extensive. A radical trachelectomy removes the entire cervix and part of the vagina, whereas a conization (cone biopsy) removes only a cone-shaped portion of the cervix containing the cancer cells. A loop electrosurgical excision procedure (LEEP) is similar to a cone biopsy, and is performed with an electrified wire loop. A simple trachelectomy removes only the cervix, and in some ways is more similar to a large conization.
Trachelectomy vs. pelvic exenteration
During a pelvic exenteration, the cervix, ovaries, vagina, lymph nodes, lower colon, bladder and rectum are removed. This major surgical procedure is typically reserved for recurrent or very advanced cancers in the pelvic area. These may include cancers of the female reproductive organs and colorectal cancer, if it has spread.
Non-surgical alternatives to a trachelectomy
Radiotherapy is a very common non-surgical treatment option. It can be used to treat cervical cancer of different stages, with the decision hinging on factors, such as the desire to retain fertility and the likelihood of complications. In some cases, radiotherapy will be used in combination with chemotherapy – which is known as chemoradiotherapy – or in combination with surgery.
Trachelectomy vs. radiotherapy
Radiotherapy uses high-energy X-rays to destroy cancerous cells. It can be delivered either externally, using a large, specially designed machine which beams X-rays into the pelvis, or internally, whereby a radioactive tube is placed inside the vagina, adjacent to the tumor. Generally, a combination of the two methods is used. Radiotherapy may involve a variety of side-effects, including the risk of infertility. For this reason, a trachelectomy may be preferred by women for whom fertility is a concern. Radiotherapy is rarely used alone; in most cases, it is used in combination with chemotherapy.
Trachelectomy vs. chemoradiotherapy
Chemoradiotherapy is radiotherapy and chemotherapy used in combination. This treatment method can help to remove the cancer and lessen the chances of it recurring. Radiotherapy is administered in the manner described above, while chemotherapy uses cytotoxic drugs administered intravenously to destroy cancer cells.
Trachelectomy and fertility
Women who wish to preserve their fertility may opt for a trachelectomy over a hysterectomy. Since the uterus remains intact after a trachelectomy, pregnancy can still occur. Roughly 97 percent of people who have undergone trachelectomy surgery, eventually return to a normal menstrual cycle. However, doctors may advise delaying any attempt to conceive for approximately two years.
Conception may be difficult. The risk of miscarriage among people who have had a trachelectomy is significantly higher than the norm, and any fetus carried to term must be delivered by caesarian section (C-section).
Trachelectomy surgery is carried out in a hospital, under general anesthetic. It may be performed either vaginally or abdominally: vaginal surgery is the most commonly performed method, though abdominal surgery may be more appropriate for people with larger cancerous lesions.
Abdominal trachelectomy may be performed by hand, or be laparoscopic or robotically assisted. Laparoscopic surgery is less painful, with a shorter recovery time and a lower risk of infection, though it also increases the risk of damage to the surrounding organs and the urinary tract. Robotically-assisted trachelectomy takes longer to perform, but has a shorter recovery time, with less potential for blood loss and fewer possible complications. As a trachelectomy is not a common surgical procedure, it is often performed at specialized gynecological centers.
Recovery time and the potential for side-effects depend on the method used in performing the trachelectomy. Most people recover in a hospital at first, and most take medications for pain management and the avoidance of infection or blood clots.
In general, people are advised to get plenty of rest and avoid heavy exertion. They should not have sexual intercourse or place anything in the vagina, such as a tampon. They should also avoid bathing while seated, and avoid excessive strain during a bowel movement. After several weeks – and when they are no longer taking pain medication – they may resume driving a car.
It is important that people avoid taking aspirin while recovering from a trachelectomy, as it may increase the risk of bleeding.
Depending on the type of surgery performed, people will receive different recommendations for taking care of the wound. In all cases, they should inspect the wound regularly for any signs of infection such as redness, separation, swelling or drainage.
After returning home from the hospital, individuals may need another person to assist them with their daily activities. Loose clothes and underwear, as well as sanitary pads for bleeding and discharge may also be advised.
If a person experiences a high fever (above 100.4°F/38°C), excessive bleeding, abdominal or chest pain, foul-smelling vaginal discharge, fainting, or difficulty breathing or urinating, they should contact a doctor. People experiencing any symptoms that may be linked to a trachelectomy can also carry out a symptom assessment using the free Ada app.
Risks and side-effects of trachelectomy
A trachelectomy is a major surgical procedure that comes with inherent risks. Though it offers a way to preserve a person’s fertility during cervical cancer treatment, pregnancy will have a higher risk of miscarriage and other complications. Other risks or side-effects may include:
- Infection or bleeding
- Scar tissue, which may increase the risk of infertility or uterine infection
- Blood clotting
- Damage to the urinary tract or nearby organs
- Hernia or blocked bowel
- Difficulty urinating or urinary incontinence
- Vaginal discharge
- Painful intercourse
- Irregular or painful menstrual cycle
- Swelling of the vulva or exterior genitals
- Numbness of the thighs
- Lymphedema (when lymph fluid collects in the limbs) or lymphocele (when it collects in the abdomen) due to lymph node removal
Women are advised to talk to a doctor about any complications of a trachelectomy they may be experiencing. Additionally, the Ada app can be used to carry out a symptom assessment.
Q: Is a trachelectomy painful?
A: A trachelectomy is performed under general anesthetic, while a person is unconscious. As a result, the procedure itself will not be painful, but there may be some pain or tenderness around the location of the wound after the procedure, as well as a general feeling of achiness or exhaustion. While still in hospital, pain relief will normally be supplied. Pain during intercourse and a painful menstrual cycle are also possible complications of a trachelectomy. Talk to a doctor if these complications occur.
Q: Is it possible to have a trachelectomy after a hysterectomy?
A: Yes, it is possible to have a trachelectomy after a hysterectomy. This is usually necessary when the retained cervix, sometimes termed the cervical stump, is at risk of symptoms or disease following the initial hysterectomy. It is estimated that new cervical symptoms will arise in around one quarter of women who undergo a hysterectomy.
Q: What is the difference between a simple trachelectomy and a radical trachelectomy?
A: A radical trachelectomy is the most commonly performed type of the procedure, involving the removal of the cervix and a portion of the vagina. A simple trachelectomy, on the other hand, removes only the cervix.
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“Surgical Procedures: Radical Cervical Trachelectomy.” OncoLink. Accessed: August 1, 2017 ↩ ↩ ↩
“Abdominal scar characteristics as a predictor of cervical stenosis after abdominal radical trachelectomy.” Oncotarget. May 12, 2016. Accessed: February 7, 2018. ↩
The Christie NHS Foundation Trust. “Radical Trachelectomy: A guide for patients and their carers.” Accessed August 2, 2018. ↩
UpToDate. “Trachelectomy following supracervical hysterectomy.” November 7, 2017. Accessed August 2, 2018. ↩