Trachelectomy

In gynecologic oncology, trachelectomy, also cervicectomy, is a surgical removal of the uterine cervix. [Trachelectomy. baymoon.com. URL: [http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm] . Accessed: September 30, 2007.] 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. [cite journal |author=Dursun P, Ayhan A, Kuscu E |title=New surgical approaches for the management of cervical carcinoma |journal= |volume= |issue= |pages= |year=2007 |pmid=17768027 |doi=10.1016/j.ejso.2007.07.012]

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 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. [cite journal |author=Tanguay C, Plante M, Renaud MC, Roy M, Têtu B |title=Vaginal radical trachelectomy in the treatment of cervical cancer: the role of frozen section |journal=Int. J. Gynecol. Pathol. |volume=23 |issue=2 |pages=170–5 |year=2004 |month=April |pmid=15084846 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=23&issue=2&spage=170] It is usually done with a lymphadenectomy, to assess for tumour spread to the lymph nodes.

imple

A "simple trachelectomy" refers to the removal of the cervix; this can be considered to be a very large conization procedure.cite journal |author=Rob L, Pluta M, Strnad P, "et al" |title=A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer |journal=Gynecol. Oncol. |volume= |issue= |pages= |year=2008 |month=August |pmid=18725167 |doi=10.1016/j.ygyno.2008.07.021 |url=]

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 nodes. [cite journal |author=Pahisa J, Alonso I, Torné A |title=Vaginal approaches to fertility-sparing surgery in invasive cervical cancer |journal=Gynecol. Oncol. |volume=110 |issue=3S2 |pages=S29–S32 |year=2008 |month=September |pmid=18585766 |doi=10.1016/j.ygyno.2008.05.005 |url=] However, it is not yet considered the standard of care; hysterectomy is the standard of care. [cite journal |author=Ramirez PT, Levenback C |title=Radical trachelectomy: is it here to stay? |journal=Gynecol. Oncol. |volume=94 |issue=3 |pages=611–3 |year=2004 |pmid=15350348 |doi=10.1016/j.ygyno.2004.07.031]

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 recurrence and death are similar when compared to standard treatments (radical hysterectomy and radiation).cite journal |author=Dursun P, LeBlanc E, Nogueira MC |title=Radical vaginal trachelectomy (Dargent's operation): a critical review of the literature |journal=Eur J Surg Oncol |volume=33 |issue=8 |pages=933–41 |year=2007 |month=October |pmid=17208407 |doi=10.1016/j.ejso.2006.11.021 |url=] Death and cancer recurrence rates (associated with the procedure) are approximately 3% and 5% respectively. [Data. trachelectomy.co.uk. URL: [http://www.trachelectomy.co.uk/schedule.htm http://www.trachelectomy.co.uk/schedule.htm] . Accessed on: August 28, 2008.] [cite journal |author=Beiner ME, Covens A |title=Surgery insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer |journal=Nat Clin Pract Oncol |volume=4 |issue=6 |pages=353–61 |year=2007 |month=June |pmid=17534391 |doi=10.1038/ncponc0822 |url=]

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. [cite journal |author=Jolley JA, Battista L, Wing DA |title=Management of pregnancy after radical trachelectomy: case reports and systematic review of the literature |journal=Am J Perinatol |volume=24 |issue=9 |pages=531–9 |year=2007 |month=October |pmid=17899494 |doi=10.1055/s-2007-986680 |url=] Delivery is by caesarean section.

ee also

*Adenocarcinoma
*Cervical cancer staging
*Oncology

References

External links

* [http://www.cancerhelp.org.uk/help/default.asp?page=9188 Which surgery for cervical cancer] - cancerhelp.org.uk
* [http://www.trachelectomy.co.uk/Trachelectomy.htm Royal Marsden Hospital Trachelectomy Patient Information Leaflet] - trachelectomy.co.uk.