Trachelectomy
Encyclopedia
In gynecologic oncology
, trachelectomy, also cervic
ectomy, is a surgical removal of the uterine
cervix
. As the uterine body is preserved, this type of surgery is a fertility
preserving surgical
alternative to a radical hysterectomy and applicable in selected younger women with early cervical cancer
.
The word radical is used as, in addition to the cervix
(like in radical hysterectomies), the parametria (tissue adjacent to the cervix) and vaginal cuff (the end of the vagina
close to the cervix) are also excised as a part of the operation. It is usually done with a lymphadenectomy
, to assess for tumour spread to the lymph nodes.
procedure.
s. However, it is not yet considered the standard of care
; hysterectomy is the standard of care.
Conization is considered the standard treatment for less advanced cancers (stage 1A1).
recurrence and death are similar when compared to standard treatments (radical hysterectomy and radiation
). Death and cancer recurrence rates (associated with the procedure) are approximately 3% and 5% respectively.
.
Gynecologic oncology
Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, endometrial cancer, cervical cancer, and vulvar cancer...
, trachelectomy, also cervic
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
ectomy, is a surgical removal of the uterine
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
. As the uterine body is preserved, this type of surgery is a fertility
Fertility
Fertility is the natural capability of producing offsprings. As a measure, "fertility rate" is the number of children born per couple, person or population. Fertility differs from fecundity, which is defined as the potential for reproduction...
preserving surgical
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
alternative to a radical hysterectomy and applicable in selected younger women with early cervical cancer
Cervical cancer
Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...
.
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 cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
(like in radical hysterectomies), the parametria (tissue adjacent to the cervix) and vaginal cuff (the end of the vagina
Vagina
The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...
close to the cervix) are also excised as a part of the operation. It is usually done with a lymphadenectomy
Lymphadenectomy
Lymphadenectomy consists of the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer....
, to assess for tumour spread to the lymph nodes.
Simple
A simple trachelectomy refers to the removal of the cervix; this can be considered to be a very large conizationCervical conization
Cervical conization refers to a biopsy of the cervix in which a cone-shaped sample of tissue is removed from the mucous membrane. Conization may be used either for diagnostic purposes, or for therapeutic purposes to remove pre-cancerous cells.Types include:* cold knife conization...
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 nodeLymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s. However, it is not yet considered the standard of care
Standard of care
In tort law, the standard of care is the 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 breached is determined by the trier of fact, and is usually...
; 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 cancerCancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
recurrence and death are similar when compared to standard treatments (radical hysterectomy and radiation
Radiation
In physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...
). 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, because of the loss of the cervix risk of pregnancy loss and preterm delivery is significantly higher, when compared to healthy women. Delivery is by caesarean sectionCaesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...
.
External links
- Which surgery for cervical cancer - cancerhelp.org.uk
- Royal Marsden Hospital Trachelectomy Patient Information Leaflet - trachelectomy.co.uk.