CPT® Code 57531

1. Indications

The radical trachelectomy procedure described by CPT® Code 57531 is indicated for specific conditions related to cervical cancer. The following are the primary indications for performing this surgical intervention:

• Early-stage cervical cancer - This procedure is typically indicated for patients diagnosed with early-stage cervical cancer, particularly those with tumors that are confined to the cervix and have not spread to surrounding tissues.
• Desire to preserve fertility - The procedure is often chosen by younger patients who wish to maintain their ability to conceive and carry a pregnancy after treatment for cervical cancer.

2. Procedure

The radical trachelectomy procedure involves several detailed steps, which are outlined as follows:

• Step 1: Lymphadenectomy and Node Sampling - The procedure begins with a bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling. This is performed using a laparoscopic, transperitoneal, or retroperitoneal approach. The surgeon dissects the pelvic lymph nodes, including the external and common iliac nodes, hypogastric nodes, and obturator nodes, freeing them from surrounding tissues. These lymph nodes are then removed and sent for frozen section analysis to assess for cancer spread.
• Step 2: Biopsy of Para-aortic Lymph Nodes - After the pelvic lymph nodes are removed, the para-aortic lymph nodes are exposed. Biopsies are taken from these nodes and also sent for frozen section analysis to evaluate for malignancy.
• Step 3: Inspection and Possible Removal of Tubes and Ovaries - Following the lymphadenectomy, the surgeon inspects the fallopian tubes and ovaries. If necessary, these structures may be removed. The round ligament is transected, and the posterior leaf of the broad ligament is opened. The infundibulopelvic ligament is undermined using blunt dissection, and the ureter is identified and protected during this process. The infundibulopelvic ligament is then clamped, incised, and suture ligated. The fallopian tube, suspensory ligament, and mesosalpinx are clamped and transected near the uterine opening, allowing for the removal of the tube and ovary. This step is repeated on the opposite side as needed.
• Step 4: Resection of the Uterine Cervix - The next step involves the resection of the uterine cervix, which can be performed via an abdominal, vaginal, or combined approach. The uterine vessels are ligated at their origins, and the body of the uterus (uterine corpus) is transected just above the internal cervical os. The cervix is removed along with parametrial tissue and a portion of the vagina, which is also sent for frozen section analysis. Further resection of the uterus is performed as necessary until all tumor tissue and an adequate margin of healthy tissue have been excised.
• Step 5: Fertility Preservation Techniques - In younger patients wishing to preserve fertility, a catheter is placed in the uterine opening (neocervix) to maintain patency. A cerclage is placed around the uterus, and the proximal vaginal margins are sutured to the body of the uterus to support future pregnancies.

3. Post-Procedure

Post-procedure care following a radical trachelectomy includes monitoring for complications such as bleeding, infection, and urinary issues. Patients may require pain management and should be advised on activity restrictions during the recovery period. Follow-up appointments are essential to assess healing and to monitor for any signs of cancer recurrence. Additionally, patients who have undergone this procedure and wish to conceive in the future may need specialized care and monitoring during pregnancy due to the changes in their anatomy and the absence of the cervix.