Trachelectomy (sometimes known as a cervicectomy) refers to removal of uterine cervix.
It is sometimes performed as a uterine sparing surgery for certain cases with cervical malignancy 2-3. When it is performed with curative intent it is often termed a radical trachelectomy and is often accompanied by a pelvic lymphadenectomy. The procedure is usually performed women of child bearing age or younger.
Suggested criteria for patient eligibility for a radical trachelectomy includes4:
- 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
- absence of adenocarcinoma in intra-operative pathologic specimens
- absence of capillary space involvement in intra-operative pathologic specimens
- limited endocervical involvement at colposcopic examination
- no evidence of pelvic lymph node metastasis
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 artifacts arise from two sources : the anastomotic sutures and the cerclage suture, which is placed around the corpus uteri to preserve competence during pregnancy. These artifacts are most pronounced with fast spin-echo T2-weighted sequences
- vaginal appearances
- there can be diffuse wall thickening since atrachelectomy 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.
- 1. Sahdev A, Jones J, Shepherd JH et-al. MR imaging appearances of the female pelvis after trachelectomy. Radiographics. 25 (1): 41-52. doi:10.1148/rg.251045047 - Pubmed citation
- 2. 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. - Pubmed citation
- 3. Rodriguez M, Guimares O, Rose PG. Radical abdominal trachelectomy and pelvic lymphadenectomy with uterine conservation and subsequent pregnancy in the treatment of early invasive cervical cancer. Am. J. Obstet. Gynecol. 2001;185 (2): 370-4. doi:10.1067/mob.2001.115866 - Pubmed citation
- 4. Hindman N, Israel GM, Krinsky GA. Case 114: radical trachelectomy. Radiology. 2007;243 (3): 898-900. doi:10.1148/radiol.2433041068 - Pubmed citation