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Radical Trachelectomy (Fertility-Sparing Cervical Cancer Surgery)

Fertility-preserving oncologic procedure for early-stage cervical cancer in young women, removing the cervix, parametrium, and upper vagina while preserving the uterine body and ovaries to enable future pregnancy via assisted or spontaneous conception with cerclage support.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Radical Trachelectomy (Fertility-Sparing Cervical Cancer Surgery)?

Radical trachelectomy is an oncologic surgical procedure designed to treat early-stage cervical cancer in women who wish to preserve fertility, removing the cervix, parametrial tissue, and upper vagina while preserving the corpus uteri, fallopian tubes, and ovaries, allowing potential future pregnancy.

Procedure can be performed by vaginal (Dargent), abdominal (open or robotic), or laparoscopic approach, and is combined with pelvic lymphadenectomy or sentinel node biopsy to assess nodal status; cerclage placement is performed at completion to support future pregnancy.

Patient selection criteria include FIGO stage IA1 with lymphovascular invasion through IB1 (lesion 2 cm or less), squamous cell carcinoma or adenocarcinoma histology, no distant metastases, no pelvic lymph node involvement, and strong patient desire to preserve fertility, with informed consent regarding oncologic and obstetric risks.

Symptoms

Confirmed early-stage cervical cancer (FIGO IA1 with LVSI, IA2, or IB1 ≤2 cm) on biopsy and imaging
Strong patient desire for future fertility despite cancer diagnosis
Possible postoperative cervical stenosis with dysmenorrhea or amenorrhea
Postoperative hematometra in case of cervical stenosis requiring dilation
Sexual dysfunction including dyspareunia, decreased sensation, or vaginal shortening
Pregnancy after trachelectomy with high risk of preterm birth, preterm premature rupture of membranes, and second-trimester loss

Risk Factors

Tumor size greater than 2 cm or deep stromal invasion increase recurrence risk
Lymphovascular space invasion despite small tumor size
Adenocarcinoma may have slightly higher recurrence risk than squamous cell carcinoma in some series
Pelvic lymph node involvement found at sentinel or full lymphadenectomy
Inadequate margins (less than 5 mm) requiring conversion to definitive radical hysterectomy
Failure to complete oncologic resection due to anatomic or technical issues

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Young woman with newly diagnosed early-stage cervical cancer who wishes to preserve fertility — referral to gynecologic oncology center experienced in radical trachelectomy
  • Postoperative menstrual or pregnancy concerns: cervical stenosis, dysmenorrhea, infertility — gynecologic oncology and reproductive endocrinology consultation
  • Pregnancy after trachelectomy — early referral to high-risk obstetrics with cerclage management and preterm birth prevention
  • Suspected recurrence with abnormal bleeding, pelvic pain, or imaging findings — urgent oncologic restaging
  • Long-term oncologic follow-up: regular pelvic exam, cytology, HPV testing, and imaging according to protocol

Treatment Methods

01
Comprehensive preoperative workup: pelvic MRI for tumor size and parametrial extension, cervical biopsy with histology, sentinel lymph node mapping or pelvic lymphadenectomy, and reproductive counseling
02
Surgical approach selected by surgeon expertise and patient anatomy: vaginal radical trachelectomy with laparoscopic lymphadenectomy, abdominal radical trachelectomy (open or robotic), or laparoscopic radical trachelectomy
03
Permanent cervical cerclage placement with non-absorbable suture at the level of the internal os to support future pregnancy
04
Adjuvant therapy considered in case of intermediate or high-risk pathologic features (tumor size, depth of stromal invasion, lymphovascular space invasion) following NCCN/ESGO guidelines
05
Long-term oncologic surveillance combined with reproductive endocrinology and high-risk obstetric care during pregnancy, including cervical length monitoring and elective cesarean delivery

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.