Radical trachelectomy

A radical trachelectomy is surgery to remove the cervix, the upper part of the vagina and surrounding supporting tissues. As part of the surgery, lymph nodes in the pelvis are often removed to check whether cancer has spread beyond the cervix. A radical trachelectomy is also called a radical cervicectomy.

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 in the future.

A radical trachelectomy is done in the hospital under a general anesthetic (you will be unconscious) or a spinal anesthetic (you will be awake but not able to feel the surgery). This surgery involves 2 steps. The first step is removing the lymph nodes in the pelvis and checking them for cancer spread. The second step is removing the cervix, the upper part of the vagina and surrounding supporting tissues.

The surgeon begins by removing the lymph nodes in the pelvis, which is called a pelvic lymph node dissection (PLND). A PLND may be done using open surgery or a laparoscopic technique. Find out more about lymph node dissection.

While you remain in the operating room under general anesthetic, the pelvic lymph nodes are looked at under a microscope to check for cancer cells. If cancer is found in the lymph nodes, the surgery will be stopped. If no cancer is found, the surgeon will then do the second step, the radical trachelectomy.

The surgeon removes the cervix, the upper part of the vagina and supporting tissue around the cervix (called the parametrial tissue). The rest of the uterus, fallopian tubes and ovaries are 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.

There are different methods to do a radical trachelectomy:

A vaginal radical trachelectomy (VRT) removes the cervix and the nearby supporting tissue through the vagina.

An abdominal radical trachelectomy removes the cervix and nearby supporting tissue through a large incision (surgical cut) in the abdomen.

A laparoscopic radical trachelectomy uses a thin, tube-like instrument with a light and lens (called a laparoscope). The surgeon makes small surgical cuts in the abdomen. The laparoscope and other instruments are passed through the small cuts into the abdomen to remove the cervix and nearby tissues.

At the end of the surgery, the surgeon partially closes the opening of the remaining uterus, where the cervix used to be, with a special stitch that is like a drawstring. This opening allows menstrual flow during your monthly period. A temporary catheter may be placed in the artificial opening to help keep it from closing.

The cervical tissue that is removed during surgery is looked at under a microscope to see if there are any cancer cells. If there are cancer cells at or near to the edge of the removed tissue (called positive or close 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 with an adequate normal margin of tissue.

If you have a catheter 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 to 4 months for the first 2 to 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 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:

• pain
• bleeding
• infection
• bladder problems such as not being able to empty the bladder completely
• painful sexual intercourse
• vaginal discharge
• numbness in the thighs
• painful or irregular periods

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. But because lymph nodes in the pelvis are removed, you may experience a buildup of lymph fluid in the legs or in the abdomen. This is called lymphedema. Or you may experience urinary incontinence, which may also be called stress incontinence. It means you leak some urine, most likely when you cough or sneeze.

Some women can have fertility and pregnancy problems because their cervix has been removed. 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). If you do get pregnant after a radical trachelectomy, you have an increased risk of miscarriage and premature birth. You will also need to deliver a baby by Cesarean section (C-section) rather than vaginally.

Find out more about lymphedema, urinary incontinence and fertility problems.