Trachelectomy Following Supracervical Hysterectomy

Objective: The purpose of this study was to assess the reasons for trachelectomy following supracervical hysterectomy. Methods: A retrospective chart review was performed for all women undergoing trachelectomy following supracervical hysterectomy between January 1999 and October 2009 at Northwestern University's Prentice Women's Hospital. Data collected included demographics, indications, and pathology for both the supracervical hysterectomy and trachelectomy, as well as surgical modalities used and complications for each procedure. Results: Over a 10-year period, 27 trachelectomies were performed. The preoperative indications for supracervical hysterectomy in these 27 patients were: leiomyomata (16), abnormal uterine bleeding (4), pelvic pain (3), pelvic mass (2), prolapse (1), and complex atypical endometrial hyperplasia (1). The indications for trachelectomy were: pathologic evidence of uterine malignancy in 9 patients (33%), including 5 endometrial cancers, 3 stromal sarcomas, and 1 leiomyosarcoma; interval diagnosis of cervical malignancy in 2 patients (7%); interval development of cervical dysplasia in 5 patients (19%); and various benign conditions, such as pain (2), bleeding (5), prolapse (2), cervical fibroid (1), and pelvic mass (1), in 11 patients (41%). Conclusions: A small, but clinically important proportion of patients undergoing supracervical hysterectomy for apparent benign disease will require trachelectomy because of the pathologic finding of uterine malignancy in the hysterectomy specimen or the subsequent development of cervical intraepithelial neoplasia or cancer.