| Trachelectomy | |
|---|---|
 Diagram showing the parts removed with a trachelectomy | |
| ICD-9-CM | 67.4 |
In gynecologic oncology, trachelectomy, also called cervicectomy, is a surgical removal of the uterine cervix. [1] 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. [2]
Trachelectomies, broadly, can be divided into the simple and radical variants.
The formal name of this operation is radical vaginal trachelectomy (RVT) and also known as the Dargent operation and radical trachelectomy.[ citation needed ]
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. [3] 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 1st time in 1993. [4]
A simple trachelectomy refers to the removal of the cervix; this can be considered to be a very large conization procedure. [5]
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. [6] However, it is not yet considered the standard of care; hysterectomy is the standard of care. [7]
Conization is considered the standard treatment for less advanced cancers (stage 1A1).
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). [8] Death and cancer recurrence rates (associated with the procedure) are approximately 3% and 5% respectively. [9] [10]
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 and preterm delivery. [11] Subsequent delivery is by caesarean section.
The cervix or cervix uteri is the lower part of the uterus (womb) in the human female reproductive system. The cervix is usually 2 to 3 cm long and roughly cylindrical in shape, which changes during pregnancy. The narrow, central cervical canal runs along its entire length, connecting the uterine cavity and the lumen of the vagina. The opening into the uterus is called the internal os, and the opening into the vagina is called the external os. The lower part of the cervix, known as the vaginal portion of the cervix, bulges into the top of the vagina. The cervix has been documented anatomically since at least the time of Hippocrates, over 2,000 years ago.
Cervical cancer is a cancer arising from the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.
Hysterectomy is the partial or total surgical removal of the uterus. It may also involve removal of the cervix, ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. Partial hysterectomies allow for hormone regulation while total hysterectomies do not.
Endometrial cancer is a cancer that arises from the endometrium. It is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body. The first sign is most often vaginal bleeding not associated with a menstrual period. Other symptoms include pain with urination, pain during sexual intercourse, or pelvic pain. Endometrial cancer occurs most commonly after menopause.
Heavy menstrual bleeding (HMB), previously known as menorrhagia or hematomunia, is a menstrual period with excessively heavy flow. It is a type of abnormal uterine bleeding (AUB).
Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender-affirming surgery. Some people born with a vagina who identify as trans men or as nonbinary may choose vaginectomy in conjunction with other surgeries to make the clitoris more penis-like (metoidioplasty), construct of a full-size penis (phalloplasty), or create a relatively smooth, featureless genital area.
Primary peritoneal cancer or carcinoma is also known as serous surface papillary carcinoma, primary peritoneal carcinoma, extra-ovarian serous carcinoma, primary serous papillary carcinoma, and psammomacarcinoma. It was historically classified under "carcinoma of unknown primary" (CUP). Primary peritoneal cancer is a cancer of the cells lining the peritoneum, or abdominal cavity.
The cardinal ligament is a major ligament of the uterus formed as a thickening of connective tissue of the base of the broad ligament of the uterus. It extends laterally from the cervix and vaginal fornix to attach onto the lateral wall of the pelvis. The female ureter, uterine artery, and inferior hypogastric (nervous) plexus course within the cardinal ligament. The cardinal ligament supports the uterus.
Gynecologic oncology is a specialized field of medicine that focuses on cancers of the female reproductive system, including ovarian cancer, uterine cancer, vaginal cancer, cervical cancer, and vulvar cancer. As specialists, they have extensive training in the diagnosis and treatment of these cancers.
Steven A. Vasilev is an American gynecologist, specializing in gynecologic oncology. He has served as Professor and Director of Integrative Medicine and Gynecologic Oncology at John Wayne Cancer Institute-Providence Saint John’s Health Center, Professor at John Wayne Cancer Institute in Santa Monica, California, and Professor at Loma Linda University School of Medicine faculty. Vasilev is a proponent of minimally invasive (laparoscopic) and robotic cancer surgery and complex pelvic surgery and has published research on medical and surgical therapies, integrative medicine, and screening for cervical cancer and human papilloma virus (HPV)
Primary fallopian tube cancer (PFTC), often just tubal cancer, is a malignant neoplasm that originates from the fallopian tube.
Uterine serous carcinoma is a malignant form of serous tumor that originates in the uterus. It is an uncommon form of endometrial cancer that typically arises in postmenopausal women. It is typically diagnosed on endometrial biopsy, prompted by post-menopausal bleeding.
Neuroendocrine carcinoma of the cervix is best defined separately:Neuroendocrine: Of, relating to, or involving the interaction between the nervous system and the hormones of the endocrine glands.Carcinoma: An invasive malignant tumor derived from epithelial tissue that tends to metastasize to other areas of the body.
A cervical pregnancy is an ectopic pregnancy that has implanted in the uterine endocervix. Such a pregnancy typically aborts within the first trimester, however, if it is implanted closer to the uterine cavity – a so-called cervico-isthmic pregnancy – it may continue longer. Placental removal in a cervical pregnancy may result in major hemorrhage.
Uterine adenosarcoma is an uncommon form of cancer that arises from mesenchymal tissue of the uterus and has a benign glandular component.
A lymphocele is a collection of lymphatic fluid within the body not bordered by epithelial lining. It is usually a surgical complication seen after extensive pelvic surgery and is most commonly found in the retroperitoneal space. Spontaneous development is rare.
The Wertheim–Meigs operation is a surgical procedure for the treatment of cervical cancer performed by way of an abdominal incision.
Gynecologic cancer disparities in the United States refer to differences in incidence, prevalence, and mortality from gynecologic cancers between population groups. The five main types of gynecologic cancer include cervical cancer, ovarian cancer, endometrial cancer, vaginal cancer, and vulvar cancer. For patients with these and other gynecologic malignancies within the United States, disparities across the care continuum by socioeconomic status and racial/ethnic background have been previously identified and studied. The causes behind these disparities are multifaceted and a complex interplay of systemic differences in health as well as individual patient factors such as cultural, educational, and economic barriers.
William Francis Victor Bonney FRCP FRCS was a prominent British gynaecological surgeon. He was described by Geoffrey Chamberlain as "a primary influence on world gynaecology in the years between the wars".
Bradley J. Monk is an American gynecologic oncologist, academician and researcher. He is a Professor on the Clinical Scholar Track in the Department of Obstetrics and Gynecology at the University of Arizona College of Medicine in Phoenix, Arizona, as well as at the Creighton University School of Medicine in Omaha, Nebraska. He also serves as Director of the Division of Gynecologic Oncology at the St. Joseph's Hospital and Medical Center in Phoenix.