Definition and Overview
Also referred to as trachelectomy, cervicectomy is the surgical removal of the cervix, a tissue that connects the uterus (womb) and the vagina. The procedure is typically performed as one of the treatment options for women who have early-stage cervical cancer and want to get pregnant.
A cervicectomy can be either radical or simple. In simple cervix removal, only the cervix and the upper part of the vagina are removed. The radical method, on the other hand, is more comprehensive and complicated as it involves the removal of surrounding tissues and lymph nodes. When making a recommendation as to what approach will be performed, the surgeon will consider several factors including the size of the tumour, health of the patient, possible risks and complications, and most importantly, if the cancer has metastasized to the lymph nodes.
Who Should Undergo and Expected Results
Cervix removal is performed on young women who have been diagnosed with early-stage cervical cancer. This means that the cancer stage is between stage 1B and 1A2. It cannot be performed if the cancer has metastasized to the lymph nodes.
Different types of tests, including MRI and biopsies, are first performed to determine the stage of cancer and the size of the tumour. For cervicectomy to be considered, the tumour should be no more than 2 centimeters.
The surgery has a very low morbidity and recurrent rate, and based on studies, the majority of patients retain their ability to get pregnant following the procedure while some may have infertility issues because of the narrowing of the cervix (stenosis) and thus may require reproductive assisted options such as in vitro fertilization. However, one of the biggest challenges that patients face after the removal of the cervix is the high risk of miscarriage or pre-term delivery.
How Does the Procedure Work?
Cervix removal is performed in a hospital and under general anaesthesia.
Before cervicectomy, the surgeon and oncologist carry out the dissection of the lymph nodes in the pelvic area (lymph node dissection) to check the presence of cancer. If the results come back positive, the surgery will not be performed and instead, the patient will be advised to undergo alternative treatments including chemotherapy. Otherwise, the surgeon proceeds with the procedure and will decide whether it will be simple or radical depending on factors mentioned above.
To access the cervix and the upper part of the vagina, the surgeon will create a single long incision (open) in the vagina or up to four small incisions (laparoscopic) in the abdomen. Using surgical instruments, the cervix is separated from the uterus. The excised tissue will then be studied under the microscope for any traces of cancer cells. If there are, the surgeon will continue removing surrounding tissues until the sample comes back clean.
After the procedure, the uterus will be stitched. A catheter will also be inserted to facilitate drainage of urine while the wounds are healing.
Possible Risks and Complications
Short-term risks and complications include discomfort, pain, and having the need to urinate more frequently. The patient may also experience bleeding, pain during urination, and inflammation of the outside parts of the vagina including the lips. In rare cases, the patient may develop urinary incontinence (poor control of urine passage), and lymphedema (accumulation of lymph fluids) once the lymph nodes are removed.
Although one of the objectives of the procedure is to keep the uterus intact, in certain cases, cervix removal is followed up with hysterectomy if the cancer has spread to the womb. The patient may also be at risk of infertility if cancer recurs following surgery.
Sahdev A, Jones J, Shepherd JH et-al. MR imaging appearances of the female pelvis after trachelectomy. Radiographics. 25 (1): 41-52.
Dargent D, Martin X, Sacchetoni A et-al. Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. Cancer. 2000;88 (8): 1877-82.