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 person’s age, desire to maintain fertility and the cancer’s stage of development. Non-surgical treatments include radiation and chemotherapy.
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.
Trachelectomy and fertility
People 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 may be performed either vaginally or abdominally. Vaginal surgery is more commonly performed, however, abdominal surgery is 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.
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
“Cervical Cancer Treatment (PDQ®): Treatment - Patient Information [NCI] - Treatment Option Overview.” WebMD. Accessed: August 1, 2017 ↩ ↩
“A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer.” Gynecologic Oncology. Accessed: August 1, 2017 ↩
“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. ↩