Prof. Dr. Turgay Çelikel
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Cancer Surgery
Trachelectomy
What a trachelectomy (cervicectomy) is, how fertility-sparing cervical cancer surgery preserves the uterine corpus, what clinical evidence indicates regarding oncological safety and pregnancy outcomes, approximate costs in Turkey compared with the UK, US and Germany, eligibility criteria, operative steps, recovery milestones, potential complications and how to evaluate specialised gynaecological oncology hospitals.
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Trachelectomy in Turkey: what is a cervicectomy and how does it work?
A trachelectomy, also known as a cervicectomy, is an organ-preserving operation for early-stage cervical cancer that protects a woman's potential to bear children. The surgeon removes the uterine cervix, the upper one to two centimetres of the vagina, and surrounding supportive parametrial tissue, whilst keeping the uterine body, fallopian tubes, and ovaries intact. A permanent synthetic stitch (cervical cerclage) is placed at the lower uterine segment to support future pregnancies, before the uterus is re-attached to the vaginal wall.
Historically, radical hysterectomy was the standard treatment, causing permanent infertility. A trachelectomy offers a fertility-sparing alternative without compromising oncological safety when strict selection criteria are met. Hospitals in Turkey perform this procedure using vaginal, abdominal, or robotic methods in specialist cancer centres. This guide explains how the surgery works, clinical evidence on cancer control and pregnancy, approximate costs vs the UK, recovery milestones, and safety considerations. For wider cancer care, see our hub on oncology treatments in Turkey.
How is a radical trachelectomy performed step by step?
A radical trachelectomy is carried out under general anaesthesia and typically takes two to four hours. The operation follows five coordinated stages:
- Pelvic lymph node dissection: The surgeon first removes pelvic lymph nodes through keyhole incisions. These are examined immediately by frozen-section pathology. If cancer cells are found, the procedure is discontinued in favour of systemic therapy or hysterectomy.
- Isolating adjacent organs: Once lymph nodes are confirmed clear, the surgeon separates the bladder, rectum, and ureters safely from the cervix.
- Cervical resection: The cervix, upper vagina, and surrounding parametrial tissue are excised, ensuring at least a five-millimetre tumour-free margin at the upper cut.
- Cerclage placement: A permanent, non-absorbable stitch is placed around the lower uterine segment to function as an artificial cervix during future pregnancy.
- Reconstruction: The lower uterine segment is sutured to the vaginal cuff, restoring the reproductive tract.
Does trachelectomy work for cancer control and future pregnancy?
Clinical evidence demonstrates that radical trachelectomy provides oncological safety equivalent to radical hysterectomy in carefully selected patients. Guidelines from the European Society of Gynaecological Oncology (ESGO) and the National Comprehensive Cancer Network (NCCN) confirm five-year recurrence-free survival rates of 95% or higher for tumours up to two centimetres with clear lymph nodes. Cancer recurrence rates remain between 3% and 5%, matching radical hysterectomy.
Regarding fertility, international data show that 40% to 70% of women who attempt pregnancy after surgery successfully conceive, either naturally or through assisted reproductive techniques. However, pregnancies are high-risk: without a biological cervix, the risk of second-trimester miscarriage and premature labour rises. Furthermore, the permanent cerclage means every delivery must be performed by elective caesarean section.
Trachelectomy cost in Turkey compared with the UK, US and Germany
The figures below reflect approximate cost ranges for radical trachelectomy across four countries. These ranges are estimates rather than fixed hospital quotations, as prices depend on surgical approach and required hospital days.
| Country | Approximate cost range |
|---|---|
| Turkey | €6,000 – €14,000 |
| United Kingdom | €14,000 – €28,000 |
| United States | €25,000 – €55,000 |
| Germany | €15,000 – €30,000 |
Costs vary according to whether surgery is performed vaginally, via open laparotomy, or with robotic assistance, which carries additional instrument fees. Other factors include intraoperative frozen-section pathology fees, intensive care backup, and pre-operative staging MRI scans. Hospital packages in Turkey typically cover consultations, anaesthesia, hospitalisation, histopathology, routine medication, and airport transfers. You can request a free quote tailored to your medical records.
Trachelectomy, conization or radical hysterectomy?
The choice between cervical surgical procedures depends on disease stage, tumour dimensions, and fertility desires. The primary surgical options compare as follows:
| Surgical option | Primary indication | Uterus preserved? | Typical limits & trade-offs |
|---|---|---|---|
| Cervical conization (cone biopsy) | Microinvasive disease (FIGO stage IA1 without LVSI) | Yes | Insufficient for lesions with deep invasion or stage IB1 tumours |
| Radical trachelectomy (cervicectomy) | Stage IA2 to IB1 cervical tumours (≤2 cm) wishing to preserve fertility | Yes (uterine body and ovaries kept) | Higher risk of second-trimester loss; caesarean delivery mandatory |
| Radical hysterectomy | Stage IA2 to IB2 cervical tumours when childbearing is complete | No (entire uterus removed) | Permanent loss of fertility; standard oncological benchmark |
Conization removes only a small tissue cone and suits only microscopic lesions. Radical hysterectomy eliminates childbearing entirely. Just as breast-conserving surgery such as a lumpectomy preserves healthy tissue while clearing margins, trachelectomy balances oncological safety with organ preservation.
Who is an eligible candidate for fertility-sparing cervicectomy?
Candidate eligibility is governed by strict international oncological protocols. Suitable candidates generally meet the following criteria:
- Confirmed FIGO stage IA2 or IB1 cervical carcinoma (tumour diameter ≤ 2 cm).
- Histology of squamous cell carcinoma or standard adenocarcinoma (excluding neuroendocrine or clear cell subtypes).
- No deep cervical stromal invasion, with at least 5 mm of tumour-free tissue below the internal os.
- No lymph node metastases or distant disease on pelvic MRI and intraoperative frozen section.
- A clear wish to preserve fertility after receiving obstetric risk counselling.
Women with tumours exceeding two centimetres, disease extending into the uterine cavity, or documented lymph node spread are not eligible and require standard radical surgery or chemoradiotherapy.
What results and monitoring should you expect after surgery?
Final paraffin histopathology reports are typically ready five to seven days after surgery. This detailed analysis verifies that all margins are microscopically clear and confirms that lymph nodes contain no micrometastases. If unexpected cancer cells are detected in the margins or nodes, completion hysterectomy or chemoradiotherapy is recommended to ensure curative treatment.
When margins are clear, regular surveillance is essential. Professional societies recommend pelvic examinations, vault Pap smears, and HPV testing every three to four months for two years, and every six months up to five years. Pelvic MRI scans are generally repeated at six to twelve months. Fertility specialists advise waiting six to twelve months after surgery before attempting pregnancy to permit the neocervical tissue to heal completely.
Recovery step by step and your stay in Turkey
International patients traveling to Turkey for a trachelectomy should plan a total stay of ten to fourteen days. Recovery milestones unfold across several stages:
- Hospital stay (Days 1 to 4): Patients stay three to four nights. A urinary catheter remains in place while bladder nerves recover from surgery. Gentle walking begins on the first post-operative day with compression stockings to prevent blood clots.
- Hotel rest (Days 5 to 7): After catheter removal and oral pain control are established, you rest in your hotel, keeping activity light.
- Clinical review (Days 8 to 12): The gynaecological oncologist reviews final histopathology, inspects healing incisions, and conducts an ultrasound. A fit-to-fly certificate is issued once recovery is confirmed.
- Weeks 2 to 6: Normal desk work can typically resume after four to six weeks. Heavy lifting over five kilograms and strenuous exercise remain restricted for eight weeks.
- Weeks 6 to 8: Strict pelvic rest (no sexual intercourse, no tampons, and no bathing) must be observed for six to eight weeks until the vaginal vault suture line heals completely.
Risks and potential complications of a trachelectomy
Every major oncological operation involves potential risks. Recognized complications documented by gynaecological oncology societies include:
- Bladder voiding dysfunction: Dissection near pelvic nerves can cause temporary difficulty emptying the bladder. Normal function usually returns within two to four weeks.
- Cervical stenosis: The new opening may narrow as scar tissue matures, causing painful periods or difficulty conceiving. Stenosis can be managed with gentle outpatient dilatation.
- Lower limb lymphoedema: Pelvic lymph node removal affects lymphatic drainage. Between 5% and 10% of patients experience leg swelling, managed with compression garments and physiotherapy.
- Bleeding and infection: Pelvic haematoma, infection, or adjacent organ injury occurs in fewer than 2% of procedures in experienced hands.
- Obstetric complications: Later pregnancies carry heightened risks of premature rupture of membranes and preterm labour, requiring care from a maternal-fetal medicine specialist.
How to choose a gynaecological oncology hospital and red flags
A trachelectomy requires a specialised tertiary cancer centre with certified gynaecological oncologists. Comprehensive cancer hospitals that handle complex abdominal procedures, such as the removal of colon cancer, maintain the multidisciplinary pathology and intensive care infrastructure needed for complex pelvic oncology.
Essential standards include on-site frozen-section pathology, a weekly Multidisciplinary Tumour Board (MDT), and access to high-risk obstetric and neonatal units. Red flags include operating without high-resolution MRI scans, promising guaranteed pregnancy, operating on tumours over two centimetres, or lacking frozen-section facilities. Review how it works before planning travel, or submit your medical records for a free quote.
Questions to ask your surgical oncology team
Before proceeding with surgery, discuss these specific questions with your gynaecological oncologist:
- How many fertility-sparing radical trachelectomies do you perform each year?
- Which surgical approach (vaginal, laparoscopic, robotic, or open) do you recommend for my tumour?
- Will my pelvic lymph nodes be examined by frozen section during the operation?
- What is the contingency plan if margins or lymph nodes show positive cancer cells?
- What material and stitch technique will you use for the permanent cerclage?
- How is temporary urinary retention managed if bladder recovery is delayed?
- How will your team share pathology reports and scan findings with my local doctor?
Hospitals with Oncology in Turkey
Frequently asked questions
A trachelectomy, also called a cervicectomy, is an operation that removes the cervix, upper vagina, and surrounding tissue while preserving the uterine body, fallopian tubes, and ovaries. It is performed for women with early-stage cervical cancer who wish to preserve their ability to carry a biological pregnancy in the future.
In carefully selected patients with tumours two centimetres or smaller and clear lymph nodes, clinical studies show that radical trachelectomy provides oncological disease control equivalent to a radical hysterectomy. Five-year recurrence-free survival rates exceed 95%, and recurrence rates remain low at around 3% to 5%.
A trachelectomy in Turkey generally costs between €6,000 and €14,000, compared with €14,000 to €28,000 in the UK and up to €55,000 in the US. The total cost depends on whether surgery is performed vaginally, via open laparotomy, or with robotic assistance, alongside inpatient hospitalisation days.
Yes, preserving pregnancy is the main reason for choosing a trachelectomy. Approximately 40% to 70% of women who attempt conception after surgery successfully conceive. However, pregnancies carry higher risks of second-trimester loss and premature labour due to the missing cervix, and all deliveries must be carried out by caesarean section.
Hospital recovery takes three to four nights, during which a urinary catheter remains in place while pelvic nerves heal. Most patients return to light desk work after four to six weeks, while full pelvic healing takes six to eight weeks. Doctors advise waiting six to twelve months before attempting conception.
Surgery is performed under general anaesthesia, so you feel nothing during the operation. Afterwards, patients typically experience pelvic soreness and cramping, which is managed with intravenous analgesia in hospital and oral painkillers during the first one to two weeks of home recovery as swelling and tissue tension subside.
A cone biopsy (conization) removes only a small cone-shaped piece of cervical tissue and is suitable only for microscopic pre-cancer or stage IA1 disease. A radical trachelectomy removes the entire cervix, adjacent parametrial tissue, and upper vagina, accompanied by pelvic lymph node dissection for larger, invasive tumours.
When carried out by a certified gynaecological oncologist in an accredited tertiary hospital, radical trachelectomy is considered oncologically safe and standard. Specific risks include temporary bladder voiding difficulty, cervical stenosis, or lower limb swelling, which are monitored closely by the surgical and nursing teams.
Patients usually stay three to four nights in the hospital followed by outpatient recovery in a hotel. A total stay of ten to fourteen days in Turkey is recommended to monitor wound healing, review final pathology reports with the multidisciplinary board, and ensure fitness before flying home.
Oncological follow-up requires physical examinations, vaginal vault cytology (Pap smear), and HPV testing every three to four months for the first two years, then every six months until year five. Pelvic MRI scans are typically conducted at six to twelve months to ensure pelvic tissues remain clear.
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