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Review paper
Published online: 2020-12-30
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Radical hysterectomy and its importance in the concept of cervical cancer treatment

Kamila Kazmierczak, Błazej Nowakowski
DOI: 10.5603/GP.a2020.0148
·
Pubmed: 33448011

open access

Ahead of Print
REVIEW PAPERS Gynecology
Published online: 2020-12-30

Abstract

The role and place of a radical hysterectomy in the concept of cervical cancer treatment, despite over one hundred years
of its traditional use, still excites controversy.
To fully understand the value of the surgical treatment, it is worth analysing and understanding the evolutionary path of
the radical hysterectomy and the changes that have occurred in this method over the years. This knowledge will allow for
a better understanding as to why the choice of therapy between surgery and radiochemotherapy in the early and locally
advanced stages of cervical cancer still raise doubts.
Both the introduced changes in the scope of surgery and the use of multi-module treatment - surgery with subsequent
radiation therapy did not significantly improve the results of cancer treatment, but significantly increased the prevalence
of side effects and therapy complications.
As cervical cancer most often affects relatively young women, the number of potential years of life after treatment is high.
Over 30% of women in Poland with cervical cancer are in the 45–49 years-old age group. From the perspective of these
data, obtaining a high therapeutic index, which is defined as the ratio of the number of healed patients to complications
and side effects of treatment significantly reducing the quality of life, is very important in the therapy process.
Regardless of the classical radical surgery, which has evolved over many years, a new concept of radical hysterectomy based
on tissue morphogenesis, called total mesometrial resection (TMMR) with therapeutic Lymph Node Dissection (tLND) with
no adjuvant radiotherapy, has recently been proposed.
Based on the ontogenetic research and the study of cancerous tumour development, the concept of TMMR was first introduced
by M. Höckel in 2001. In the research conducted by the author, encouraging results of the treatment of stages IB1,
IB2, IIA1 and IIA2, and selected cases of stage IIB [according to 2009 International Federation of Gynecology and Obstetrics
(FIGO)] cervical cancer were obtained.

Abstract

The role and place of a radical hysterectomy in the concept of cervical cancer treatment, despite over one hundred years
of its traditional use, still excites controversy.
To fully understand the value of the surgical treatment, it is worth analysing and understanding the evolutionary path of
the radical hysterectomy and the changes that have occurred in this method over the years. This knowledge will allow for
a better understanding as to why the choice of therapy between surgery and radiochemotherapy in the early and locally
advanced stages of cervical cancer still raise doubts.
Both the introduced changes in the scope of surgery and the use of multi-module treatment - surgery with subsequent
radiation therapy did not significantly improve the results of cancer treatment, but significantly increased the prevalence
of side effects and therapy complications.
As cervical cancer most often affects relatively young women, the number of potential years of life after treatment is high.
Over 30% of women in Poland with cervical cancer are in the 45–49 years-old age group. From the perspective of these
data, obtaining a high therapeutic index, which is defined as the ratio of the number of healed patients to complications
and side effects of treatment significantly reducing the quality of life, is very important in the therapy process.
Regardless of the classical radical surgery, which has evolved over many years, a new concept of radical hysterectomy based
on tissue morphogenesis, called total mesometrial resection (TMMR) with therapeutic Lymph Node Dissection (tLND) with
no adjuvant radiotherapy, has recently been proposed.
Based on the ontogenetic research and the study of cancerous tumour development, the concept of TMMR was first introduced
by M. Höckel in 2001. In the research conducted by the author, encouraging results of the treatment of stages IB1,
IB2, IIA1 and IIA2, and selected cases of stage IIB [according to 2009 International Federation of Gynecology and Obstetrics
(FIGO)] cervical cancer were obtained.

Get Citation

Keywords

cervical cancer, radical hysterectomy, total mesometrial resection

About this article
Title

Radical hysterectomy and its importance in the concept of cervical cancer treatment

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Review paper

Published online

2020-12-30

DOI

10.5603/GP.a2020.0148

Pubmed

33448011

Keywords

cervical cancer
radical hysterectomy
total mesometrial resection

Authors

Kamila Kazmierczak
Błazej Nowakowski

References (31)
  1. NCCN. Guidelines version 4: cervical cancer. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf (7.04.2020).
  2. Jach R, Sznurkowski J, Bidziński M, et al. Recommendations of the Polish Gynecological Oncology Society for the diagnosis andtreatment of cervical cancer. Current Gynecologic Oncology. 2017; 15(1): 24–33.
  3. Bhatla N, Berek JS, Cuello Fredes M, et al. Revised FIGO staging for carcinoma of the cervix uteri. Int J Gynaecol Obstet. 2019; 145(1): 129–135.
  4. Wertheim E. Theextended abdominal operation for carcinoma uteri (based on 500 cases). Am J Obstet Gynecol. 1912; 66: 169–232.
  5. MEIGS JV. Radical hysterectomy with bilateral pelvic lymph node dissections; a report of 100 patients operated on five or more years ago. Am J Obstet Gynecol. 1951; 62(4): 854–870.
  6. Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol. 1974; 44(2): 265–272.
  7. Landoni F, Maneo A, Cormio G, et al. Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: a prospective randomized study. Gynecol Oncol. 2001; 80(1): 3–12.
  8. Yabuki Y, Asamoto A, Hoshiba T, et al. A new proposal for radical hysterectomy. Gynecol Oncol. 1996; 62(3): 370–378.
  9. Fujii S, Takakura K, Matsumura N, et al. Anatomic identification and functional outcomes of the nerve sparing Okabayashi radical hysterectomy. Gynecol Oncol. 2007; 107(1): 4–13.
  10. The abdominal radical hysterectomy. Gynecological Operative Anatomy. .
  11. Sakuragi N, Todo Y, Kudo M, et al. A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer. 2005; 15(2): 389–397.
  12. Trimbos JB, Maas CP, Deruiter MC, et al. A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients. Int J Gynecol Cancer. 2001; 11(3): 180–186.
  13. Raspagliesi F, Ditto A, Fontanelli R, et al. Nerve-sparing radical hysterectomy: a surgical technique for preserving the autonomic hypogastric nerve. Gynecol Oncol. 2004; 93(2): 307–314.
  14. Mibayashi R. Results in the treatment of cervical cancer at the Kyoto University obstetrical and gynecological clinic. JPn Obstet Gynecol Soc. 1962; 14: 471–72.
  15. Höckel M. Laterally extended endopelvic resection: Surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies. American Journal of Obstetrics and Gynecology. 1999; 180(2): 306–312.
  16. PÁLFALVI L, Ungár L. Laterally extended parametrectomy (LEP), the technique for radical pelvic side wall dissection: Feasibility, technique and results. Int J Gynecol Cancer. 2003; 13(6): 914–917.
  17. Martin X, Saccchetoni A, Mathevet P. Laaproscopic vaginal radical trachelectomy. Cancer. 2000; 88: 1877–1882.
  18. Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008; 9(3): 297–303.
  19. Höckel M. [Total mesometrial resection: nerve-sparing extended radical abdominal hysterectomy]. Zentralbl Gynakol. 2001; 123(5): 245–249.
  20. Höckel M, Horn LC, Fritsch H. Association between the mesenchymal compartment of uterovaginal organogenesis and local tumour spread in stage IB-IIB cervical carcinoma: a prospective study. Lancet Oncol. 2005; 6(10): 751–756.
  21. Fritsch H, Lienemann A, Brenner E, et al. Clinical anatomy of the pelvic floor. Adv Anat Embryol Cell Biol. 2004; 175: III–IX, 1.
  22. Kubitschke H, Wolf B, Morawetz E, et al. Roadmap to Local Tumour Growth: Insights from Cervical Cancer. Sci Rep. 2019; 9(1): 12768.
  23. Köhler C, Le X, Dogan NU, et al. Molecular Diagnosis for Nodal Metastasis in Endoscopically Managed Cervical Cancer: The Accuracy of the APTIMA Test to Detect High-risk Human Papillomavirus Messenger RNA in Sentinel Lymph Nodes. J Minim Invasive Gynecol. 2016; 23(5): 748–752.
  24. Höckel M, Horn LC, Tetsch E, et al. Pattern analysis of regional spread and therapeutic lymph node dissection in cervical cancer based on ontogenetic anatomy. Gynecol Oncol. 2012; 125(1): 168–174.
  25. Höckel M, Horn LC, Hentschel B, et al. Total mesometrial resection: high resolution nerve-sparing radical hysterectomy based on developmentally defined surgical anatomy. Int J Gynecol Cancer. 2003; 13(6): 791–803.
  26. Höckel M, Wolf B, Schmidt K, et al. Surgical resection based on ontogenetic cancer field theory for cervical cancer: mature results from a single-centre, prospective, observational, cohort study. Lancet Oncol. 2019; 20(9): 1316–1326.
  27. Chassagne D, Sismondi P, Horiot JC, et al. A glossary for reporting complications of treatment in gynecological cancers. Radiother Oncol. 1993; 26(3): 195–202.
  28. Wolf B, Ganzer R, Stolzenburg JU, et al. Extended mesometrial resection (EMMR): Surgical approach to the treatment of locally advanced cervical cancer based on the theory of ontogenetic cancer fields. Gynecol Oncol. 2017; 146(2): 292–298.
  29. Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg. 1982; 69(10): 613–616.
  30. Landoni F, Maneo A, Colombo A, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet. 1997; 350(9077): 535–540.
  31. Cibula D, Pötter R, Planchamp F, et al. The European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology Guidelines for the Management of Patients With Cervical Cancer. Int J Gynecol Cancer. 2018; 28(4): 641–655.

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