Trachelectomy

What is a trachelectomy?

A trachelectomy is a surgical procedure used to treat early-stage cervical cancer while preserving fertility. Your gynaecologist may recommend a simple or a radical trachelectomy. A simple trachelectomy involves removal of just the cervix, whereas a radical trachelectomy involves removal of the cervix, upper portion of the vagina and nearby tissue. Sometimes, pelvic lymph nodes also removed (lymphadenectomy). Unlike a hysterectomy, a trachelectomy leaves your uterus (womb) intact, making it an option if you wish to consider pregnancy in the future.

 

Who may be a candidate for trachelectomy?

Your gynaecologist will conduct a thorough assessment, including imaging and biopsies, to determine whether a trachelectomy is the most appropriate treatment for you. It may be suitable if you:

  • Have early-stage cervical cancer, typically stage IA2 or small IB1, where the cancer is confined to the cervix.
  • Wish to preserve your fertility and maintain the possibility of future pregnancies.
  • Are in good general health and can tolerate surgery.

 

The trachelectomy procedure

Trachelectomy is a specialised procedure typically performed by a gynaecological oncologist. The surgery can be performed through different approaches:

Abdominal trachelectomy:

  • An incision is made in your abdomen to access and remove the cervix, part of the upper vagina, and surrounding tissues, including nearby lymph nodes.

Vaginal trachelectomy:

  • The surgery is performed through the vagina, which may result in a shorter recovery time and less visible scarring.

Laparoscopic or robotic-assisted trachelectomy:

  • Minimally invasive techniques may also be used, involving smaller incisions and the use of a camera and specialised instruments to perform the surgery with precision.

 

During the operation, which is performed while you are asleep under general anaesthetic, your gynaecologist will remove the following:

Simple trachelectomy:

  • The cervix only.

Radical trachelectomy:

  • The cervix
  • Tissue surrounding the cervix
  • The upper part of the vagina
  • Nearby lymph nodes (this is called lymphadenectomy)

 

The uterus is preserved. The surgeon will then attach the remaining part of the uterus to the upper vagina, and a cerclage (a stitch around the opening of the uterus) may be placed, leaving a small opening to allow menstrual flow to pass through and to help prevent miscarriage in future pregnancies.

Your gynaecologist sends the tissue to a laboratory to ensure that all the cancer has been removed from the cervix. If lymph nodes are also removed, they are sent for analysis to check for cancer cells. Since lymph nodes are part of the lymphatic system, cancer cells can spread to them first if they break away from a tumour. Your gynaecologist may remove lymph nodes to determine whether the cancer has spread.

 

Recovery after trachelectomy

Recovery from a trachelectomy typically involves:

  • Hospital stay: You may need to stay in the hospital for a few days following the procedure, depending on the surgical approach used.
  • Post-operative care: You will be advised to avoid heavy lifting, sexual activity, and strenuous exercise for several weeks to allow proper healing.
  • Follow-up appointments: Regular follow-up appointments are crucial to monitor your recovery, check for any signs of recurrence, and manage any side effects.

 

Possible risks

While trachelectomy is a safe and effective treatment option for early-stage cervical cancer, as with any surgery, there are some risks to consider. It’s important to be aware of these so that you can monitor your recovery and seek help if necessary.

Common issues after trachelectomy

  • Infection: Look out for fever, increased pain, redness, swelling, or discharge at the surgical site may indicate an infection. If you suspect an infection, contact your gynaecologist immediately for treatment, which typically involves antibiotics.
  • Bleeding: Contact your gynaecologist if you experience heavy bleeding or large clots
  • Increased risk of preterm birth and miscarriage: Due to the removal of the cervix.  A cerclage stitch may help and additional precautions during pregnancy may be recommended.
  • Scar tissue formation: May cause painful periods or fertility issues. Further surgical procedures may be needed in some cases.
  • Fertility issues: While the uterus is preserved, fertility may still be affected, and not all women will be able to conceive naturally after the procedure.
  • Urinary and bowel issues: Difficulties with urination, incontinence, or constipation may occur usually temporary. If persistent treatment or physiotherapy may be required.
  • Emotional and psychological impact: Related to fertility, recovery, and cancer recurrence may arise. Talking to your gynaecologist, support groups, and counselling can help.
  • Recurrence of cancer: There is a small risk of cancer recurrence after trachelectomy. Regular follow-up visits with your oncologist are crucial for early detection and intervention.

 

What are the benefits?

  • Preserved Fertility: The procedure preserves the uterus and the ability to become pregnant.
  • Less Blood Loss and Shorter Hospital Stay: Compared to a hysterectomy, a trachelectomy often results in less blood loss and a shorter hospital stay.

 

Fertility and pregnancy after trachelectomy

One of the key benefits of trachelectomy is the potential to preserve fertility. However, pregnancy after a trachelectomy requires careful monitoring and management:

  • Increased risk of preterm birth: Due to the removal of the cervix, there is an increased risk of preterm birth and miscarriage. Your healthcare team may recommend additional precautions during pregnancy.
  • Specialist care: Pregnancies following trachelectomy are considered high-risk, and you will need to be under the care of a specialist team experienced in managing such pregnancies.

 

Support and follow-up care

At Birmingham Gynaecology Clinic, we provide comprehensive support throughout your treatment journey. This includes:

  • Pre-operative counselling: Discussing your treatment options, potential outcomes, and fertility preservation with our specialist team.
  • Post-operative care: Ensuring you have the necessary support during your recovery period, including pain management and wound care.
  • Long-term follow-up: Regular check-ups to monitor for any signs of cancer recurrence and to support your overall health and well-being.

 

Why choose Birmingham Gynaecology Clinic?

At Birmingham Gynaecology Clinic, our experienced team specialises in trachelectomy, offering personalised care tailored to your needs. We use advanced, minimally invasive techniques to ensure the best possible outcomes while preserving your fertility.

 

Contact us

If you’re considering trachelectomy, have been diagnosed with early-stage cervical cancer or need expert advice, contact us today. Our team of specialists is here to guide you through your treatment options, provide expert care, and support you every step of the way.

 

 

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