Trachelectomy: a review of 15 cases

To determine the indications and complications of removal of the retained cervical stump (trachelectomy).

Retrospective review of the records of 15 cases of removal of the retained cervical stump performed at the Department of Surgical Oncology NCI Cairo University and Nasser Institute Cairo between January 2005 and December 2009.

Fifteen patients were identified with a mean age of 43.1±8.4 years. The indications for subtotal hysterectomy were uterine fibroids, 7 (46.7%), abnormal bleeding, 5 (33.3%), and ovarian mass, 3 (20%) cases. Route of trachelectomy was abdominal in all cases. The indications for trachelectomy were cervical malignancy in 8 (53.3%), residual tumor at the hysterectomy specimen in 3 (20%), and persistent bleeding in 2 (13.3%) cases. The most common concomitant procedures with the trachelectomy were pelvic lymphadenectomy in 11 (73.3%), and oophorectomy in 10 (66.6%) cases. There were no postoperative mortalities. The most common complications were wound infection, 4 (26.6%), and urinary tract infection, 3 (20%). The mean estimated blood loss was 341.0± 82.3ml. Hospital stay was 7.9±5.1 days. The most common histological diagnosis was squamous carcinoma 9 cases (60%). The median follow-up period was 16 months.

Subtotal hysterectomy carries the risk of developing a stump cancer. Patient agreement is mandatory. Subtotal hysterectomy should be avoided whenever possible in populations with restricted access to screening programs for cancer of the uterine cervix.

Trachelectomy - Cervical stump.