Definition of compartment-based radical surgery in uterine cancer: radical hysterectomy in cervical cancer as ‘total mesometrial resection (TMMR)’ by M Höckel translated to robotic surgery (rTMMR)

Abstract

BackgroundRadical hysterectomy has been developed as a standard treatment in Stage I and II cervical cancers with and without adjuvant therapy. However, there have been several attempts to standardize the technique of radical hysterectomy required for different tumor extension with variable success. Total mesometrial resection as ontogenetic compartment-based oncologic surgery - developed by open surgery - can be standardized identically for all patients with locally defined tumors. It appears to be promising for patients in terms of radicalness as well as complication rates. Robotic surgery may additionally reduce morbidity compared to open surgery. We describe robotically assisted total mesometrial resection (rTMMR) step by step in cervical cancer and present feasibility data from 26 patients.MethodsPatients (n = 26) with the diagnosis of cervical cancer were included. Patients were treated by robotic total mesometrial resection (rTMMR) and pelvic or pelvic/periaortic robotic therapeutic lymphadenectomy (rtLNE) for FIGO stage IA-IIB cervical cancer.ResultsNo transition to open surgery was necessary. No intraoperative complications were noted. The postoperative complication rate was 23%. Within follow-up time (mean: 18 months) we noted one distant but no locoregional recurrence of cervical cancer. There were no deaths from cervical cancer during the observation period.ConclusionsWe conclude that rTMMR and rtLNE is a feasible and safe technique for the treatment of compartment-defined cervical cancer.

Self-Reported Long-Term Autonomic Function After Laparoscopic Total Mesometrial Resection for Early-Stage Cervical Cancer: A Multicentric Study

“…The diffusion of this approach through the scientific community has been associated with a continuous improvement of the technique, so that TMMR can be now safely performed through minimally invasive laparoscopic 5 and robotic routes. 15 Furthermore, recently published data demonstrated encouraging results in term of perioperative outcome in patients receiving laparoscopic or robotic TMMR, without differences between the 2 groups. 16 On the other hand, it is well known that impairment of pelvic functions, particularly in term of urinary outcome, represents the most relevant issue of standard minimally invasive RH, 17,18 even when nerve-sparing technique is adopted.…”

ICG-gestützte Navigation bei der Chirurgie uteriner Malignome

“…Zervixkarzinompatientinnen (n = 36) wurden mit einer radikalen Hysterektomie und therapeutischen ± pelvinen/paraaortalen Lymphonodektomie behandelt, entweder als totale mesometriale oder als peritoneale mesometriale Resektion (TMMR oder PMMR; [14][15][16] Zervixkarzinompatientinnen (n = 20, mittleres Alter 44 Jahre, FIGO-Stadium Ib-IIb) erhielten eine TMMR mit therapeutischer Lymphonodektomie [14,15]. Alle Resektionen waren bestätigt R0 (mittlere Lymphknotenzahl n = 57).…”

Definition of compartment-based radical surgery in uterine cancer: modified radical hysterectomy in intermediate/high-risk endometrial cancer using peritoneal mesometrial resection (PMMR) by M Höckel translated to robotic surgery

“…The training of the first author, the development and description of the surgical technique of robotic total mesometrial resection (rTMMR) and periaortic robotic therapeutic lymphadenectomy (rtLNE) have recently been described [12,13]. In close cooperation with M Höckel, the method of rPMMR has been developed and surgical steps to remove ontogenetically-derived compartments of permissive tumor progression have been defined.…”

“…Particular steps are identical to rTMMR and the accordant technique has been previously described [13]. …”