A Decade of Experience with Radical Abdominal Trachelectomy after Supracervical Hysterectomy

Abstract

Background: The supracervical hysterectomy is no longer indicated for the treatment of female genital disease.
Patient and Methods: All women who had trachelectomy after supracervical hysterectomy between 2010 and 2020 had their records reviewed at Cairo University's National Cancer Institute (NCI) Hospital.
Results: A total of 34 trachelectomy surgeries were performed during a ten-year period. The patients were 42 to 72 years old, with a mean +SD of 55+7.5. Recurrent vaginal bleeding was the reason for trachelectomy in 67.6% of cases due to residual disease found in hysterectomy specimens, with pathologic evidence of uterine malignancy in 47.2%, and 11.7 percent of patients had cervical malignancy. Uterine stromal sarcoma was found in 5.9% of the cases. There were 11.8% of cases with uterine fibroids, 7.8% with endometrial hyperplasia, and 2.9 % with uterine adenomyosis who had true benign lesions. There were no pathology reports available in 8.8% of the cases. The pathology of the trachelectomy revealed that 26.5% of patients had no residual disease, while 73.5% had the residual disease in the cervical stump, with 32.4% having cervical squamous cell carcinoma, 20.6% having uterine adenocarcinoma, 8.8% having cervical adenocarcinoma, and 2.9% having cervical adenosquamous. Mullerian carcinoma was found in 2.9% of the cases, whereas undifferentiated carcinoma was found in 2.9%. In 61.8% of cases, bilateral pelvic lymphadenectomy was coupled with trachelectomy for radical excision of gross malignancy.
Conclusions: A significant number of patients who had a subtotal hysterectomy for apparent benign illness required trachelectomy within a few months.