# Trachelectomy

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Surgical removal of the uterine cervix

Medical intervention

Trachelectomy Diagram showing the parts removed with a trachelectomy ICD-9-CM 67.4 [edit on Wikidata]

In [gynecologic oncology](/source/Gynecologic_oncology), **trachelectomy**, also called **cervicectomy**, is a surgical removal of the [uterine](/source/Uterus) [cervix](/source/Cervix).[1] As the uterine body is preserved, this type of surgery is a [fertility](/source/Fertility) preserving [surgical](/source/Surgery) alternative to a [radical hysterectomy](/source/Radical_hysterectomy) and applicable in selected younger women with early [cervical cancer](/source/Cervical_cancer).[2]

## 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](https://en.wikipedia.org/wiki/Wikipedia:Citation_needed)*]

The word *radical* is used as, in addition to the [cervix](/source/Cervix) (like in radical hysterectomies), the parametria (tissue adjacent to the cervix) and [vaginal cuff](/source/Vaginal_cuff) (the end of the [vagina](/source/Vagina) close to the cervix) are also excised as a part of the operation.[3] It is usually done with a [lymphadenectomy](/source/Lymphadenectomy), to assess for tumour spread to the [lymph nodes](/source/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.[4]

### Simple

A *simple trachelectomy* refers to the removal of the cervix; this can be considered to be a very large [conization](/source/Cervical_conization) procedure.[5]

## 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](/source/Cervical_cancer#Staging) or mild [stage IB1](/source/Cervical_cancer#Staging) 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](/source/Lymph_node).[6] However, it is not yet considered the [standard of care](/source/Standard_of_care); hysterectomy is the standard of care.[7]

[Conization](/source/Cervical_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](/source/Cancer) recurrence and death are similar when compared to standard treatments (radical hysterectomy and [radiation](/source/Radiation)).[8] Death and cancer recurrence rates (associated with the procedure) are approximately 3% and 5% respectively.[9][10]

## Pregnancy post-trachelectomy

Following RVT, approximately 70% of patients that want to have children are able to conceive.[8] However, absence of the cervix increases the risk of [miscarriage](/source/Miscarriage) and preterm delivery.[11] Subsequent delivery is by [caesarean section](/source/Caesarean_section).

## See also

- [Adenocarcinoma](/source/Adenocarcinoma)

- [Cervical cancer staging](/source/Cervical_cancer_staging)

- [Oncology](/source/Oncology)

- [List of surgeries by type](/source/List_of_surgeries_by_type)

## References

1. **[^](#cite_ref-1)** Trachelectomy. baymoon.com. URL: [http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm](http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm) [Archived](https://web.archive.org/web/20070927143641/http://www.baymoon.com/~gyncancer/library/glossary/bldeftrachelect.htm) 2007-09-27 at the [Wayback Machine](/source/Wayback_Machine). Accessed: September 30, 2007.

1. **[^](#cite_ref-2)** Dursun P, Ayhan A, Kuscu E (2007). "New surgical approaches for the management of cervical carcinoma". *European Journal of Surgical Oncology*. **34** (5): 487–96. [doi](/source/Doi_(identifier)):[10.1016/j.ejso.2007.07.012](https://doi.org/10.1016%2Fj.ejso.2007.07.012). [PMID](/source/PMID_(identifier)) [17768027](https://pubmed.ncbi.nlm.nih.gov/17768027).

1. **[^](#cite_ref-3)** Tanguay C, Plante M, Renaud MC, Roy M, Têtu B (April 2004). "Vaginal radical trachelectomy in the treatment of cervical cancer: the role of frozen section". *Int. J. Gynecol. Pathol*. **23** (2): 170–5. [doi](/source/Doi_(identifier)):[10.1097/00004347-200404000-00012](https://doi.org/10.1097%2F00004347-200404000-00012). [PMID](/source/PMID_(identifier)) [15084846](https://pubmed.ncbi.nlm.nih.gov/15084846). [S2CID](/source/S2CID_(identifier)) [21653042](https://api.semanticscholar.org/CorpusID:21653042).

1. **[^](#cite_ref-Surbone2007_4-0)** Surbone A, Peccatori F, Pavlidis N (2007-11-09). [*Cancer and Pregnancy*](https://books.google.com/books?id=1zJoGkLj9UUC&pg=PT88). Springer Science & Business Media. pp. 88–. [ISBN](/source/ISBN_(identifier)) [978-3-540-71274-9](https://en.wikipedia.org/wiki/Special:BookSources/978-3-540-71274-9).

1. **[^](#cite_ref-rob_5-0)** Rob L, Pluta M, Strnad P, et al. (August 2008). "A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer". *Gynecol. Oncol*. **111** (2 Suppl): S116–S120. [doi](/source/Doi_(identifier)):[10.1016/j.ygyno.2008.07.021](https://doi.org/10.1016%2Fj.ygyno.2008.07.021). [PMID](/source/PMID_(identifier)) [18725167](https://pubmed.ncbi.nlm.nih.gov/18725167).

1. **[^](#cite_ref-6)** Pahisa J, Alonso I, Torné A (September 2008). "Vaginal approaches to fertility-sparing surgery in invasive cervical cancer". *Gynecol. Oncol*. **110** (3S2): S29–S32. [doi](/source/Doi_(identifier)):[10.1016/j.ygyno.2008.05.005](https://doi.org/10.1016%2Fj.ygyno.2008.05.005). [PMID](/source/PMID_(identifier)) [18585766](https://pubmed.ncbi.nlm.nih.gov/18585766).

1. **[^](#cite_ref-7)** Ramirez PT, Levenback C (2004). "Radical trachelectomy: is it here to stay?". *Gynecol. Oncol*. **94** (3): 611–3. [doi](/source/Doi_(identifier)):[10.1016/j.ygyno.2004.07.031](https://doi.org/10.1016%2Fj.ygyno.2004.07.031). [PMID](/source/PMID_(identifier)) [15350348](https://pubmed.ncbi.nlm.nih.gov/15350348).

1. ^ [***a***](#cite_ref-dursun_8-0) [***b***](#cite_ref-dursun_8-1) Dursun P, LeBlanc E, Nogueira MC (October 2007). "Radical vaginal trachelectomy (Dargent's operation): a critical review of the literature". *Eur J Surg Oncol*. **33** (8): 933–41. [doi](/source/Doi_(identifier)):[10.1016/j.ejso.2006.11.021](https://doi.org/10.1016%2Fj.ejso.2006.11.021). [PMID](/source/PMID_(identifier)) [17208407](https://pubmed.ncbi.nlm.nih.gov/17208407).

1. **[^](#cite_ref-9)** Data. trachelectomy.co.uk. URL:[http://www.trachelectomy.co.uk/schedule.htm](http://www.trachelectomy.co.uk/schedule.htm) [Archived](https://web.archive.org/web/20081017113645/http://www.trachelectomy.co.uk/schedule.htm) October 17, 2008, at the [Wayback Machine](/source/Wayback_Machine). Accessed on: August 28, 2008.

1. **[^](#cite_ref-10)** Beiner ME, Covens A (June 2007). "Surgery insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer". *Nat Clin Pract Oncol*. **4** (6): 353–61. [doi](/source/Doi_(identifier)):[10.1038/ncponc0822](https://doi.org/10.1038%2Fncponc0822). [PMID](/source/PMID_(identifier)) [17534391](https://pubmed.ncbi.nlm.nih.gov/17534391). [S2CID](/source/S2CID_(identifier)) [8856242](https://api.semanticscholar.org/CorpusID:8856242).

1. **[^](#cite_ref-11)** Jolley JA, Battista L, Wing DA (October 2007). "Management of pregnancy after radical trachelectomy: case reports and systematic review of the literature". *Am J Perinatol*. **24** (9): 531–9. [doi](/source/Doi_(identifier)):[10.1055/s-2007-986680](https://doi.org/10.1055%2Fs-2007-986680). [PMID](/source/PMID_(identifier)) [17899494](https://pubmed.ncbi.nlm.nih.gov/17899494). [S2CID](/source/S2CID_(identifier)) [20118144](https://api.semanticscholar.org/CorpusID:20118144).

## External links

- [Which surgery for cervical cancer](http://www.cancerhelp.org.uk/help/default.asp?page=9188) - cancerhelp.org.uk

- [Royal Marsden Hospital Trachelectomy Patient Information Leaflet](https://web.archive.org/web/20081005002421/http://www.trachelectomy.co.uk/Trachelectomy.htm) - trachelectomy.co.uk.

v t e Tests and procedures involving the female reproductive system Gynecological surgery Ovaries Oophorectomy Salpingoophorectomy Fallopian tubes Falloposcopy Salpingectomy Tubal ligation Essure Tubal reversal Uterus General: Genitoplasty Hysterectomy Hysterotomy Pelvic exenteration Uterine artery embolization Transplantation Uterine cavity: Hysteroscopy Vacuum aspiration Endometrium: Endometrial biopsy Endometrial ablation Myometrium: Uterine myomectomy Cervix: Colposcopy Cervical conization LEEP Cervical cerclage Cervical screening (Pap test) Cervicectomy Pessary insertion Vagina Vaginectomy Culdoscopy Culdocentesis Episiotomy husband stitch Hymenotomy Colpocleisis Hymenorrhaphy Vaginal wet mount Vaginal transplantation Vulva Vulvectomy Female genital mutilation Labiaplasty Clitoral hood reduction Vestibulectomy Medical imaging Gynecologic ultrasonography Hysterosalpingography

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Adapted from the Wikipedia article [Trachelectomy](https://en.wikipedia.org/wiki/Trachelectomy) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Trachelectomy?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.