gynecologic oncology Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer. As specialists, they have extensive ...

, trachelectomy, also called cervicectomy, is a surgical removal of the

uterine The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the hollow organ, organ in the female reproductive system, reproductive system of most female mammals, including humans that accommodates the embryonic development, embryonic an ...

cervix The cervix or cervix uteri (Latin, 'neck of the uterus') is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long (~1 inch) and roughly cylindrical in shape, which changes during ...

. As the uterine body is preserved, this type of surgery is a

fertility Fertility is the capability to produce offspring through reproduction following the onset of sexual maturity. The fertility rate is the average number of children born by a female during her lifetime and is quantified demographically. Fertili ...

preserving

surgical Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

alternative to a

radical hysterectomy Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), Fallopian tubes (salpingectomy), and other surrounding structures. Usually performed by a gynecologist, a hysterectomy may be ...

and applicable in selected younger women with early

cervical cancer Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal ...

Types

Trachelectomies, broadly, can be divided into the ''simple'' and ''radical'' variants.

Radical

The formal name of this operation is ''radical vaginal trachelectomy (RVT)'' and also known as the ''Dargent operation'' and ''radical trachelectomy''. The word ''radical'' is used as, in addition to the

(like in radical hysterectomies), the parametria (tissue adjacent to the cervix) and

vaginal cuff The vaginal cuff is the upper portion of the vagina that opens up into the peritoneum and is sutured shut after the removal of the cervix and uterus during a hysterectomy. The vaginal cuff is created by suturing together the edges of the surgi ...

(the end of the

vagina In mammals, the vagina is the elastic, muscular part of the female genital tract. In humans, it extends from the vestibule to the cervix. The outer vaginal opening is normally partly covered by a thin layer of mucosal tissue called the hymen ...

close to the cervix) are also excised as a part of the operation. It is usually done with a

lymphadenectomy Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the ...

, to assess for tumour spread to the

lymph nodes A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

. This operation was pioneered by the renowned French Obstetrician-Gynecologist Surgeon, Daniel Dargent (1937–2005), who performed it for the 1st time in 1993.

Simple

A ''simple trachelectomy'' refers to the removal of the cervix; this can be considered to be a very large

conization Cervical conization ( CPT codes 57520 (Cold Knife) and 57522 (Loop Excision)) refers to an excision of a cone-shaped sample of tissue from the mucous membrane of the cervix. Conization may be used for either diagnostic purposes as part of a biopsy ...

procedure.

Indications

Radical trachelectomy is considered to be the optimal treatment for women of age ≤40 years with a desire to preserve fertility and stage IA2 or mild stage IB1 disease; more specifically, it is deemed appropriate when the disease consists of a tumour less than or equal to 2 cm in largest dimension and has not spread to

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that inclu ...

s. However, it is not yet considered the

standard of care In tort law, the standard of care is the only degree of prudence and caution required of an individual who is under a duty of care. The requirements of the standard are closely dependent on circumstances. Whether the standard of care has been b ...

; hysterectomy is the standard of care. Conization is considered the standard treatment for less advanced cancers (stage 1A1).

Trachelectomy compared to other treatments

Data on long-term outcomes is limited. However, it appears that

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

recurrence and death are similar when compared to standard treatments (radical hysterectomy and

radiation In physics, radiation is the emission or transmission of energy in the form of waves or particles through space or through a material medium. This includes: * ''electromagnetic radiation'', such as radio waves, microwaves, infrared, visi ...

). Death and cancer recurrence rates (associated with the procedure) are approximately 3% and 5% respectively.

Pregnancy post-trachelectomy

Following RVT, approximately 70% of patients that want to have children are able to conceive. However, absence of the cervix increases the risk of

miscarriage Miscarriage, also known in medical terms as a spontaneous abortion and pregnancy loss, is the death of an embryo or fetus before it is able to survive independently. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical lo ...

and preterm delivery. Subsequent delivery is by

caesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...

References

External links

Which surgery for cervical cancer
- cancerhelp.org.uk

- trachelectomy.co.uk. {{Female genital procedures Female genital procedures