Trachelectomy

If you have cervical cancer, your care team may recommend a simple trachelectomy or a radical trachelectomy, which is a surgical procedure to remove just the cervix (simple) or as part of the radical procedure, also remove the upper portion of the vagina and nearby tissue called the parametria. Sometimes, pelvic lymph nodes are also removed in addition to the trachelectomy.

Unlike a hysterectomy, a trachelectomy leaves your womb intact, allowing you to carry children in the future, although it will require you to deliver your baby via a cesarean section and may increase the risk of miscarriage or preterm delivery.

The procedure involves the surgical placement of a special stitch (called a cerclage stitch) or band to hold the uterus closed in the same manner as the cervix.

The surgery can be done via a traditional open incision or laparoscopically using several tiny incisions. After the cervix is taken out, the uterus is reconnected to the remaining portion of the vagina.

Why is a trachelectomy performed?

A trachelectomy is used to preserve the fertility of women younger than 40 who have been diagnosed with a stage 1 cervical cancer, if the tumor is smaller than 2 cm. It isn’t indicated for patients with advanced stages of cervical cancer or those with larger masses.

How to prepare for a trachelectomy

In order to determine whether you’re a candidate for a trachelectomy, your care team will perform imaging tests such as magnetic resonance imaging (MRI) or a positron emission tomography/computed tomography (PET/CT) scan.

If the cancer has progressed beyond the cervix or it's too large for a trachelectomy, other treatment options will be recommended.

To prepare you for surgery, your doctor will:

• Provide you with instructions not to eat or drink for a certain amount of time before surgery.
• Discuss all of your medications and advise you if any should be discontinued.
• Address any other specific preoperative instructions as needed.

What to expect after a trachelectomy

During a trachelectomy, any suspicious surrounding tissue will be removed and examined to determine whether cancer is present. If it is, a hysterectomy may be necessary. If the  surgery is not advised, other therapies may be recommended.

After your surgery:

• You will stay in the hospital, but the exact length of your stay will depend on the extent and type of surgery you had.
• Your cancer care team will monitor you for two to five years post-surgery via physical examinations and biopsies several times per year.
• If you become pregnant after the surgery, you’ll need to deliver your baby via cesarean section.

Trachelectomy risks

Short-term risks of a trachelectomy include:

• Pain during sex
• Bladder issues
• Urination problems
• Abnormal vaginal discharge
• Infection
• Bleeding
• Deep vein thrombosis (swollen legs)
• Reaction to anesthesia (nausea/vomiting, dizziness, headache and/or lung infection)

In addition, while a trachelectomy may preserve your ability to carry a child compared to more extensive removals, not all patients will be able to become pregnant after the procedure. If you’re a woman of childbearing years, you may still be able to get pregnant after the surgery, but it’s important to discuss the risks with your doctor first, as pregnancy after the procedure is considered high risk. Women who do become pregnant have an increased risk of preterm delivery, and a cesarean section delivery will be necessary.

Some more serious risks with radical trachelectomy include a fistula (a false connection between two organs) that may form between the bladder, ureter or rectum to the vagina or uterus. This condition may be resolved with conservative therapies, or it may require additional surgery.