Trachelectomy

Trachelectomy (sometimes known as a cervicectomy) refers to the removal of the uterine cervix. 

It is sometimes performed as a uterine-sparing surgery for certain cases with cervical malignancy 2-3. When it is performed with the curative intent it is often termed a radical trachelectomy and is often accompanied by a pelvic lymphadenectomy. The procedure is usually performed for women of childbearing age or younger.

Suggested criteria for patient eligibility for a radical trachelectomy includes4:

  • the desire to preserve fertility
  • no clinical evidence of impaired fertility
  • stage Ia2 or Ib1 malignancy of the cervix: carcinoma of the cervix
  • lesion size larger than 2 cm
  • the absence of adenocarcinoma in intra-operative pathologic specimens
  • the absence of capillary space involvement in intra-operative pathologic specimens
  • limited endocervical involvement at the colposcopic examination
  • no evidence of pelvic lymph node metastasis

Radiographic assessment

Pelvic MRI

It considered the imaging modality of choice for assessing anatomy and disease recurrent in patients prior to and following a trachelectomy 1,4.

General imaging assessment points include 1:

  • with the resection of the cervix, the expected surgical appearance is that of an end-to-end anastomosis between the corpus uteri and the vaginal vault
  • appearance of the anastomosis at the neofornix of the vagina can vary. In ~half of cases, there can be a posterior extension of the vaginal wall appearing as a neo-posterior vaginal fornix 1
  • artefacts: suture artefacts arise from two sources: the anastomotic sutures and the cerclage suture, which is placed around the corpus uteri to preserve competence during pregnancy. These artefacts are most pronounced with fast spin-echo T2-weighted sequences
  • vaginal appearances 
    • there can be diffuse wall thickening since a trachelectomy requires the dissection of paravaginal and parametrial tissue in order to mobilize the proximal vagina and cervix prior to resection. this is reported to occur in ~7% of cases and peaking between 3 and 6 months post surgery1 
Post-procedural advice and imaging follow-up recommendations
  • patients are asked not to become pregnant until 1 year after trachelectomy 4
  • MR imaging is currently recommended in the assessment of patients at 1-year follow-up to document the status of the cervical remnant and the cerclage 4.
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Article information

rID: 17795
Synonyms or Alternate Spellings:
  • Trachelectomies
  • Cervicectomy
  • Cervicectomies

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