Trachelectomy
The radical trachelectomy (from ancient Greek τράχηλος trachelos "neck" and ectomy ) is a surgical procedure developed by Daniel Dargent in 1994 for the surgical treatment of cervical cancer while maintaining fertility by leaving part of the cervix and the body of the uterus.
Indications
The surgical method appears to be possible for patients with a potential desire to have children, for whom the sole conization is not sufficiently radical, but the complete removal of the uterus ( hysterectomy ) or Wertheim's operation is an over-treatment. With regard to the extent of the tumor, this applies to FIGO stages IA2 and IB1 with tumors <2 cm if the tumor is a squamous cell carcinoma , the lymph nodes are tumor-free and there are no other risk factors.
principle
The procedure consists of removing about 2/3 of the cervix with about half of the parametrium . The vagina is then adapted to the cervical stump. In addition, pelvic lymph nodes are removed by laparoscopy .
Pregnancy after trachelectomy
The pregnancy rate varies between 40 and 70 percent. Due to the shortened cervix, there is a significantly higher risk of ascending infection and cervical weakness with the risk of miscarriage or premature birth during pregnancy . For this reason, a complete cervical occlusion occurs in early / middle pregnancy . The delivery must be done by caesarean section
Individual evidence
- ↑ D. Dargent, JL Brun, M. Roy, P. Mathevet, I. Remy: La trachélectomie élargie (TE). An alternative à l'hystérectomie radicale dans le traitement des cancers infiltrants dévellopés sur la face extern du col utérine. In: J Obstet Gynecol. 2, 1994, pp. 285-292.
- ^ P. Dursun, E. LeBlanc, MC Nogueira: Radical vaginal trachelectomy (Dargent's operation): a critical review of the literature. In: Eur J Surg Oncol. (8), 2007, pp. 933-941. PMID 17208407
- ↑ PT Ramirez, KM Schmeler, PT Soliman, M. Frumovitz: Fertility preservation in patients with early cervical cancer: radical trachelectomy. In: Gynecol Oncol . 110 (3 Suppl 2), 2008, pp. S25-S28. PMID 18501409 .
- ^ A. Covens, P. Shaw, J. Murphy, D. DePetrillo, G. Lickrish, S. Laframboise, B. Rosen: Is radical trachelectomy a safe alternative to radical hysterectomy for patients with stage IA-B carcinoma of the cervix? In: Cancer. 86, 1999, pp. 2273-2279. PMID 10479503
- ↑ H. Hertel, M. Possover , N. Krause, A. Schneider: Fertility after radical trachelectomy in patients with early cervical cancer. In: GebFra. 61, 2001, pp. 117-120.
- ↑ M. Plante, MC Renaud, IA Hoskins, M. Roy: Vaginal radical trachelectomy: A valuable fertility-preserving option in the management of early-stage cervical cancer. A series of 50 pregnancies and review of the literature. In: Gynecol Oncol. 98, 2005, pp. 3-10.
- ↑ D. Dargent, X. Martin, A. Sacchetoni, P. Mathevet: Laparoscopic vaginal radical trachelectomy: a treatment to preserve the fertility of cervical carcinoma patients. In: Cancer. 88, 2000, pp. 1877-1882. PMID 10760765
Web links
- New surgical method enables the uterus to be preserved - pregnancy despite cervical cancer ( memento from September 25, 2009 in the web archive archive.today ) - Medical practice
- Operating method : pregnant despite cervical cancer at medica.de
- A. Schneider: Laparoscopic procedures for staging and treatment of cervical cancer. ( Memento of December 9, 2004 in the Internet Archive ) (PDF file; 62 kB)
- Royal Marsden Hospital Trachelectomy Patient Information Leaflet. ( Memento of December 23, 2008 in the web archive archive.today ) Patient information of the Royal Marsden Hospital (English)
