Radical hysterectomy / Radical trachelectomy with pelvic lymph node dissection
For a radical hysterectomy, the surgeon removes the uterus along with the tissues next to the uterus (the parametria and the uterosacral ligaments) and the upper part (about 1 -2cm) of the vagina next to the cervix. The ovaries and fallopian tubes are not removed unless there is some other medical reason to do so.
This surgery is usually performed through an abdominal incision. Often, some pelvic lymph nodes are removed as well. A radical hysterectomy and pelvic lymph node dissection are the usual treatment for stages IA2, IB of cervical cancer.
A radical trachelectomy, allows women be treated without losing their ability to have children. This procedure removes the cervix and the upper part of the vagina but not the body of the uterus.
Cancer that starts in the cervix can spread to lymph nodes in the pelvis (lymph nodes are pea-sized collections of immune system tissue). To check for lymph node spread, your surgeon might remove some of these lymph nodes. This procedure is known as a lymph node dissection or lymph node sampling.
Sometimes, in cases where the aim is to do radical trachelectomy or radical hysterectomy there is a small chance that the procedure has to be abandoned if there is evidence that the cancer has spread to lymph nodes or to other organs in the abdomen. In such a case surgery is not recommended and radiotherapy becomes the treatment of choice, while still aiming for cure.
When you wake up from anaesthesia; there will be a drip to give you the necessary fluids, a catheter will drain urine from your bladder and at times an epidural catheter to allow for adequate pain control. An oxygen mask will supply oxygen to the respiratory system. These lines will be removed when your body functions return to normal, which is usually after 24 to 48 hours. The catheter in the bladder will remain for at least 3-4 days because of the high chance of bladder dysfunction.
Surgery always carries risks
We do everything in our power to minimize these risks. General Risks include;
- Medical and anaesthetic risks associated with general anaesthetic, with epidural analgesia or with postoperative pain control do exist. The anaesthesist is the specialist that will oversee this
- Infections to the bladder, the abdominal wound or the lungs can result in a temperature
- Thromboembolic complications (formation of blood clots) in the legs that can even travel to the lungs and cause life-threatening emboli.
We give antibiotics before the skin incision in order to avoid skin and other infections. Prior to surgery all patients will have leg compressors, which simulate walking, and anticoagulants, which will prevent the formation of blood clots in the legs.
Specific Risks related to this type of surgery
- Risk of injury to pelvic organs – such as the bowel, the bladder, the ureters, blood vessels and nerves. The risk is usually low. These injuries usually get repaired during surgery. In a very small proportion of patients these injuries are not recognised during surgery or injuries may even develop after surgery. Another operation is sometimes required to repair those defects. Injury to big blood vessels may result in need of blood transfusion.
- Bladder dysfunction – Due to the required dissection of the tissue around the bladder and the ureters, the voiding sensation is disturbed so some patients will notice changes in their voiding. If the bladder dysfunction is still present after a week, the patient will be trained to perform self-catheterisation of the bladder. Bladder dysfunction beyond 4 weeks is extremely rare.
- Lymph oedema – Lymphatic fluid usually drains from the legs via the lymph glands in the pelvis and the aorta back into the blood circulation. When lymph glands have to be removed, some fluid may accumulate in the legs (lymph oedema). The risk of lymph oedema is around 15% in patients who had to have a lymph node dissection. This should be proactively managed if it occurs by specialized physiotherapists
Some other changes you might notice include:
- Shoulder tip pain – is common after laparoscopic surgery. It is caused by the CO2 gas that s needed for the surgery. It normally lasts only for a day but painkillers are not effective
- Changes in bowel habits – are not uncommon for a couple of months post surgery. Regulation of the bowels with natural remedies such as Kiwicrush, Phloe and Metamucil is helpful
- Pain after surgery – All patients receive strong painkillers during and after surgery. All patients will receive pain killers upon leaving the hospital. It is critical that all patients continue the pain medication beyond discharge from hospital for approximately 10 to 14 days.
Exercise after surgery
Whenever possible we will mobilise patients on the day or the day after a hysterectomy. Gentle exercise is possible as is light home duties. Competitive training should be avoided for a few weeks.
You may need to stay in hospital for one or two days if the procedure was done laparoscopically or 5 days if a laparotomy (opening of the abdomen) was necessary. Avoid intercourse, vaginal tampons and full baths and other factors that could disrupt wound healing or facilitate an infection. You will need 6 weeks away from work.