TRACHELECTOMY: A REVIEW OF 215 CASES

W. Hilger, A. Pizarro, J. Magrina  

Mayo Clinic, Scottsdale, AZ

OBJECTIVE: To determine the indications and complications of cases of removal of the retained cervical stump (trachelectomy).
MATERIALS AND METHODS: Retrospective chart review of all cases of removal of the retained cervical stump performed at the Mayo Clinic between 1974 and 2003. The means and standard deviations were calculated for continuous variables.  Rates were calculated for categorical variables.
RESULTS: 215 patients were identified with a mean age, parity and BMI at the time of surgery of 63.51 (SD 13.41), 2.20 (SD 1.87) and 26.43 (SD6.08). The three most common indications for supracervical hysterectomy were fibroids (27%), abnormal bleeding (16%) and pelvic mass (11%). Route of trachelectomy was vaginal 146/215 (68%), abdominal 65/215 (30%) or laparoscopic 4/215 (2%). Overall, the most common indications for trachelectomy were prolapse 104/211(49%), pelvic mass 42/211(20%) and abnormal pap smear/cervical malignancy 24/211 (11%). The three most common indications for abdominal trachelectomy were pelvic mass 35/65 (54%), pelvic pain 11/65 (17%), non-cervical cancer 9/65 (14%). The most common indications for vaginal trachelectomy were prolapse 104/211(71%), abnormal pap smear/cervical malignancy 18/146 (12%) and bleeding 12/146 (8%). Overall, the most common concomitant procedures were cystocele repair 90/211 (43%), rectocele repair 86/211 (41%) and enterocele repair 53/211 (25%). The three most common concomitant procedures with the abdominal route were oophorectomy 39/65 (60%), non-gynecologic procedures 19/65 (29%) and bowel resection 11/65 (17%). The most common concomitant procedures with the vaginal route were cystocele repair 90/146 (62%), rectocele repair 86/211 (59%) and enterocele repair 53/211 (36%). There were no complications in 105/146 (72%) of the vaginal group and 31/65 (48%) of the abdominal group. The most common complications overall were infection 32/211 (15%), perioperative bleeding 23/211 (11%) and urinary retention 18/211 (9%). The most common complications for the vaginal group were infection 16/146 (11%), urinary retention 15/146 (10%) and urinary tract infection 9/146 (6%). The most common complications for the abdominal group were infection 16/65 (25%), perioperative bleeding 15/65 (23%), and other 5/65 (8%). Overall, the mean estimated blood loss was 327 ml (SD 482.3 ml) and hospital stay was 7.9 (SD 5.1) days. The three most common histologic diagnoses were cervicitis 132/211 (63%), normal 51/211 (24%) and squamous dysplasia 19/211 (9%). More than one pathologic diagnosis was found in 16/211 (8%) of cervices and 64/211 (30%) had extra-cervical pathology. Average length of follow-up was 171.7 days (SD 462.9).
CONCLUSIONS:  Some patients with retained cervical stump will require its subsequent removal. The most common indication was prolapse followed by pelvic mass and dysplasia. Trachelectomy had few complications when performed alone or in combination with other procedures.

Key Words: trachelectomy, cervical stump, indications, complications.

Disclosure – Nothing to disclose.