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A radical trachelectomy is surgery to remove the cervix, the upper part of the vagina and lymph nodes in the pelvis. A radical trachelectomy is also called a trachelectomy and cervicectomy.
Why a radical trachelectomy is done
A radical trachelectomy is sometimes done instead of a hysterectomy to treat cervical cancer. It may be an option for younger women with early stage cervical cancer that is small (2 cm or less in size) who want to become pregnant.
A radical trachelectomy may not be available at all treatment centres.
How a radical trachelectomy is done
A radical trachelectomy is done in the hospital while you are under a general anesthetic (you will be unconscious). This surgery usually involves 2 steps. First the lymph nodes in the pelvis are removed and checked for cancer. Then the radical trachelectomy is done.
Pelvic lymph node dissection
The surgeon begins by removing the lymph nodes in the pelvis, which is called a pelvic lymph node dissection (PLND). PLND may be done using open surgery or a laparoscopic technique. Find out more about lymph node dissection.
Once they are removed, the lymph nodes are examined under a microscope to see if they have cancer cells. If no cancer is found, the surgeon will then do the radical trachelectomy. If cancer is found, the radical trachelectomy will be stopped. The woman will then have another form of treatment, such as radiation therapy and chemotherapy given together.
During a radical trachelectomy, the surgeon removes the cervix, the upper part of the vagina and some of the tissue around the cervix (called the parametrial tissue). The rest of the uterus is left in place. If only the cervix and upper part of the vagina are removed (no parametrial tissue), the procedure is called a simple trachelectomy and upper vaginectomy.
The surgeon may use different approaches to do a trachelectomy:
- Vaginal radical trachelectomy (VRT) removes the cervix and the nearby tissue through the vagina. VRT is the most commonly used approach.
- Abdominal radical trachelectomy removes the cervix and nearby tissue through the abdomen.
- Laparoscopic radical trachelectomy uses a thin, tube-like instrument with a light and lens (called a laparoscope). The surgeon makes small incisions, or surgical cuts, in the abdomen. The laparoscope and other instruments are passed through the small incisions into the abdomen to remove the cervix and nearby tissues.
At the end of the surgery, the surgeon uses a special stitch (called cerclage) to partially close the opening of the uterus where the cervix used to be. This opening allows the flow of menstrual blood during the woman’s period. A temporary catheter may be placed in the opening to help keep it from closing.
The cervical tissue that is removed during surgery is examined under a microscope to see if there are any cancer cells. If there are cancer cells at the edge of the removed tissues (called positive surgical margins), the surgeon may try to remove more tissue. In some cases, the surgeon may need to do a hysterectomy to make sure that all of the cancer is removed.
After a radical trachelectomy
If a catheter was placed in the artificial opening between the vagina and uterus, it will be removed about 3 weeks after the surgery.
Follow-up after a trachelectomy will usually include sampling tissue at the site of surgery (similar to a Pap test procedure) and a colposcopy every 3–4 months for the first 2–3 years after surgery.
Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way.
Short-term side effects
Short-term side effects can happen during, immediately after or a few weeks after a radical trachelectomy. They are usually temporary. Short-term side effects of a radical trachelectomy include:
- problems with urination, such as not being able to empty the bladder completely
- sexual problems, including painful intercourse
- vaginal discharge
- numbness in the thighs
- painful or irregular periods
- swollen vulva (the outer female sex organs, including the clitoris, vaginal lips and the opening to the vagina)
Long-term side effects
Long-term side effects can develop months or years after surgery is over and can last a long time. Most women do not have long-term side effects after a radical trachelectomy. Some women may experience:
- a buildup of lymph fluid in the limbs (called lymphedema) or in the abdomen (called lymphocele) because lymph nodes in the pelvis are removed
- urinary incontinence, particularly stress incontinence (urine leaks during certain activities that increase pressure within the abdomen)
- fertility problems and high-risk pregnancy
Some women can have fertility and pregnancy problems after a radical trachelectomy because this surgery removes the cervix. After this surgery, the tissue of the uterus can narrow at the site of surgery, which can make it difficult for sperm to pass through and fertilize an egg. If sperm can’t reach an egg, it can cause infertility (being unable to become pregnant). There is also a high risk of miscarriage and premature birth if a woman becomes pregnant after a radical trachelectomy. Women can’t give birth vaginally after a radical trachelectomy because they no longer have a cervix. The baby is delivered by Cesarean section, or C-section.