{{short description|Surgical removal of the uterine cervix}} {{Infobox interventions | Name = Trachelectomy | Image = File:Diagram showing the parts removed with trachelectomy surgery CRUK 338.svg | Caption = Diagram showing the parts removed with a trachelectomy | ICD10 = | ICD9 = {{ICD9proc|67.4}} | MeshID = | OPS301 = | OtherCodes = | HCPCSlevel2 = }} In [[gynecologic oncology]], '''trachelectomy''', also called '''cervicectomy''', is a surgical removal of the [[uterus|uterine]] [[cervix]].<ref>Trachelectomy. baymoon.com. URL: [http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm] {{Webarchive|url=https://web.archive.org/web/20070927143641/http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm |date=2007-09-27 }}. Accessed: September 30, 2007.</ref> As the uterine body is preserved, this type of surgery is a [[fertility]] preserving [[surgery|surgical]] alternative to a [[radical hysterectomy]] and applicable in selected younger women with early [[cervical cancer]].<ref>{{cite journal |vauthors=Dursun P, Ayhan A, Kuscu E |title=New surgical approaches for the management of cervical carcinoma |journal= European Journal of Surgical Oncology |volume= 34|issue= 5|pages= 487–96|year=2007 |pmid=17768027 |doi=10.1016/j.ejso.2007.07.012}}</ref>
==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'''''.{{citation needed|date=September 2020}}
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.<ref>{{cite journal |vauthors=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 |date=April 2004 |pmid=15084846 |doi= 10.1097/00004347-200404000-00012|s2cid=21653042 }}</ref> It is usually done with a [[lymphadenectomy]], to assess for tumour spread to the [[lymph nodes]]. This operation was pioneered by the renowned French Obstetrician-Gynecologist Surgeon, Daniel Dargent (1937–2005), who performed it for the first time in 1993.<ref name="Surbone2007">{{cite book|vauthors = Surbone A, Peccatori F, Pavlidis N|title=Cancer and Pregnancy|url=https://books.google.com/books?id=1zJoGkLj9UUC&pg=PT88|date=2007-11-09|publisher=Springer Science & Business Media|isbn=978-3-540-71274-9|pages=88–}}</ref>
===Simple=== A ''simple trachelectomy'' refers to the removal of the cervix; this can be considered to be a very large [[Cervical conization|conization]] procedure.<ref name=rob>{{cite journal |vauthors=Rob L, Pluta M, Strnad P |title=A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer |journal=Gynecol. Oncol. |volume= 111|issue= 2 Suppl|pages= S116–S120|date=August 2008 |pmid=18725167 |doi=10.1016/j.ygyno.2008.07.021 |display-authors=etal}}</ref>
==Indications== Radical trachelectomy is considered to be the optimal treatment for women of age ≤40 years with a desire to preserve fertility and [[Cervical cancer#Staging|stage IA2]] or mild [[Cervical cancer#Staging|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 node]]s.<ref>{{cite journal |vauthors=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 |date=September 2008 |pmid=18585766 |doi=10.1016/j.ygyno.2008.05.005 }}</ref> However, it is not yet considered the [[standard of care]]; hysterectomy is the standard of care.<ref>{{cite journal |vauthors=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}}</ref>
[[Cervical conization|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]]).<ref name=dursun>{{cite journal |vauthors=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 |date=October 2007 |pmid=17208407 |doi=10.1016/j.ejso.2006.11.021 }}</ref> Death and cancer recurrence rates (associated with the procedure) are approximately 3% and 5% respectively.<ref>Data. trachelectomy.co.uk. URL:[http://www.trachelectomy.co.uk/schedule.htm http://www.trachelectomy.co.uk/schedule.htm] {{webarchive |url=https://web.archive.org/web/20081017113645/http://www.trachelectomy.co.uk/schedule.htm |date=October 17, 2008 }}. Accessed on: August 28, 2008.</ref><ref>{{cite journal |vauthors=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 |date=June 2007 |pmid=17534391 |doi=10.1038/ncponc0822 |s2cid=8856242 }}</ref>
==Pregnancy post-trachelectomy== Following RVT, approximately 70% of patients that want to have children are able to conceive.<ref name=dursun/> However, absence of the cervix increases the risk of [[miscarriage]] and preterm delivery.<ref>{{cite journal |vauthors=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 |date=October 2007 |pmid=17899494 |doi=10.1055/s-2007-986680 |s2cid=20118144 }}</ref> Subsequent delivery is by [[caesarean section]].
==See also== * [[Adenocarcinoma]] * [[Cervical cancer staging]] * [[Oncology]] * [[List of surgeries by type]]
==References== {{reflist|2}}
==External links== * [http://www.cancerhelp.org.uk/help/default.asp?page=9188 Which surgery for cervical cancer] - cancerhelp.org.uk * [https://web.archive.org/web/20081005002421/http://www.trachelectomy.co.uk/Trachelectomy.htm Royal Marsden Hospital Trachelectomy Patient Information Leaflet] - trachelectomy.co.uk.
{{Female genital procedures}}
[[Category:Female genital procedures]] [[Category:Cervical cancer]]