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Royal Marsden Hospital Trachelectomy Patient Information Leaflet:

bulletIntroduction
bulletWho is suitable for this surgery?
bulletWhat to expect before surgery
bulletAfter surgery
bulletHospital stay
bulletDischarge information
bulletFollow-up
bulletFuture pregnancy

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Introduction

The standard treatments for cervical cancer are radical hysterectomy and/or pelvic radiotherapy. However in women that have early stage cancer of the cervix, radical trachelectomy may be used as a fertility saving treatment. This treatment has been developed in recent years by gynaecological oncologists in specialist centres around the world.

A radical trachelectomy is a surgical procedure; whereby the cervix , the upper part of the vagina, the parametrial tissue (tissue around the lower end of the uterus), and the pelvic lymph nodes are removed. The uterus (the womb) and the ovaries are not removed and so it is still possible to have children.   

 This is done in early cervical cancer; the aim being to preserve fertility.

This is done vaginally and through small incisions in the abdomen using a laparoscope, (key hole surgery).

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Who is suitable for this surgery?

Women who are considered for this surgery will be referred to a specialist centre; here they will be assessed for suitability.

This assessment will include:

- MRI/CT scan

- Examination under anaesthetic

- Review of pathology/biopsies performed at you local hospital.

The cancer must be small and confined to the cervix.

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What to expect before surgery

- You will be admitted to the ward the day before you are due to have surgery. You will have the necessary tests e.g. blood test and

- You will be seen by your surgeons, the anaesthetist, specialist nurse and ward nurses.

- The procedure will be explained to you.

- You may need a semi- pubic shave prior to surgery, the ward staff will let you know if it is desirable.

- You will have bowel preparation that may be two sachets of laxative that day and an enema the morning of surgery. You can have breakfast the day before surgery, but you will be on clear fluids, that is fluids, Jelly and Consommé for the rest of the day. 

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After surgery

- You will be in the operating theatre and recovery room for 3 – 4 hours.

- You will spend the first night after surgery in the Critical Care Unit, as a precaution, and then you will return to the ward the following day.

- You will have a drip keeping you hydrated and this will be removed when you are drinking.

- You will have antibiotics and pain- killers.

- You will have a catheter in you bladder, your Surgeons will give instructions as to when this can be removed.

- You will be closely monitored, by nursing staff; who will aim to relieve any symptoms you have.

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Hospital stay

 You will be in hospital between 5 and 7 days.

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Discharge information

- You may feel weak or tired when you go home; this may persist for a few weeks. You may feel you need to rest more than usual. Slowly increase your activity and avoid heavy chores e.g. hoovering for first few weeks.

- The Doctors or Nurses may advise you to refrain from full penetrative intercourse for up to 6 weeks, to promote healing of the top of the vagina.

- They may also suggest avoiding swimming and use of tampons for the first 6 weeks; to prevent infection to the healing area.

- You also should avoid baths for first few weeks, if this proves difficult; avoid soaking in the bath for 6 weeks.

- You may have some brown discharge from your vagina initially; if this gets heavier, foul smelling or if you have bleeding; you should contact your specialist nurse or doctor.

    - Your surgical and nursing teams will also advise you to use contraception for 6 months after the trachelectomy.

- You may return to work 4 – 6 weeks following surgery depending on your type of job.

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Follow-up

- On your first appointment, usually at 2 weeks you will be given the results of the operation. The doctor will assess how you are doing and make another appointment with you.

- In the next appointment you will have an examination and a smear test taken from the top of the vagina.

- In the next appointment you will have an examination, a colposcopy (microscopic examination of the area) and a MRI.

- After using contraception for the first 6 months and being assessed by the surgical team, you can think about getting pregnant, if that is your wish.

- You will be seen at your specialist centre for the first 5 years following surgery, usually at 3 monthly periods. Then at increasing intervals.

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Future pregnancy

When you discover that you are pregnant, you will need to contact you GP; who needs to refer you to a hospital with high- risk obstetrics and neo-natal facilities.

Babies are delivered by caesarean section at 38 weeks.

You can get more information on the statistics of children born to women following trachelectomy from your surgeon or nurse specialist.

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Last updated: January 7, 2005.