Partial trachelectomy in the elderly patient with abnormal cytology

Because of an unsatisfactory colposcopic examination, cold knife conization of the cervix is frequently required for the evaluation of postmenopausal patients with abnormal cervical cytology. With advancing age, the cervix atrophies and retracts so that conization becomes increasingly difficult and results in a tissue specimen that is frequently inadequate. Dissatisfied with the results of the standard conization procedure, the authors performed partial trachelectomy in 26 elderly patients with atrophic, retracted cervixes. The operative complications were acceptable. Twelve of the 26 patients (46%), including four with severe dysplasia and carcinoma in situ (CIS) and eight with invasive carcinoma, received additional therapy. Eleven of 14 patients (78%) with cervical intraepithelial neoplasia (CIN) had clear surgical margins; ten of these required no further therapy. The authors conclude that partial trachelectomy may be preferable to conization for the evaluation of elderly women with small, atrophic cervixes. It provides a specimen of sufficient length, so as to reduce the incidence of positive surgical margins and to decrease the need for additional therapy if no invasive neoplasia is found. The technique of partial trachelectomy is described.