Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy

Abstract

The Surgery Treatment Modality Committee of the Korean Gynecologic Oncologic Group (KGOG) has determined to develop a surgical manual to facilitate clinical trials and to improve communication between investigators by standardizing and precisely describing operating procedures.The literature on anatomic terminology, identification of surgical components, and surgical techniques were reviewed and discussed in depth to develop a surgical manual for gynecologic oncology. The surgical procedures provided here represent the minimum requirements for participating in a clinical trial. These procedures should be described in the operation record form, and the pathologic findings obtained from the procedures should be recorded in the pathologic report form. Here, we focused on radical hysterectomy and lymphadenectomy, and we developed a KGOG classification for those conditions.

A retrospective comparison of outcome in IB2 and IIA cervical cancer patients treated with primary concurrent chemoradiation versus radical hysterectomy with or without tailored adjuvant therapy

“…All radical hysterectomies were performed through an abdominal approach until 2004, but after that, the procedure was shifted to a laparoscopic surgery. All patients underwent Korean Gynecologic Oncologic Group classification of hysterectomy type C with lymphadenectomy level 2 or 3 [ 15 ]. Para-aortic node dissection was not routine procedure for patients undergoing primary RH and was surgeon's decision if the para-aortic nodes metastasis was doubtful at pre-operative imaging or intraoperatively.…”

Comparison of Laparoscopy and Laparotomy for Para-Aortic Lymphadenectomy in Women With Presumed Stage I–II High-Risk Endometrial Cancer

“…Surgical staging for endometrial cancer was performed by laparoscopy (four-port conventional) or laparotomy (midline incision). In our institution, a staging operation was routinely performed according to the Korean Gynecologic Oncology Group (KGOG) surgical manual (11). Regarding lymphadenectomy, pelvic lymph nodes removal was performed from the distal one-half of the common iliac artery to the circumflex iliac vein, and nodal tissue was removed at anterior of the obturator nerve and around the iliac vessels.…”

Tailoring radicality in early cervical cancer: how far can we go?

“…Over the years surgeons have tried to standardize the extend of radicality of the RH in order to “speak the same language.” From 1974 till 2017 various proposals for standardization of radicality were published (Table 1) [789101112]. These different types of radicality concerned the radicality of the parametrium, the pararectal and paracolpal tissues, with or without classifying nerve sparing surgery as a separate entity.…”

“…These different types of radicality concerned the radicality of the parametrium, the pararectal and paracolpal tissues, with or without classifying nerve sparing surgery as a separate entity. Others also tried to standardize the extend of lymphadenectomy in either 3 classifications [13] or 4 classifications [12] on the basis of the anatomic regions of the pelvic and para aortic lymphatic basin. Because of the direct relationship between extend of RH and morbidity, especially bladder morbidity, many gynecologic oncologists want to diminish the extend of the parametrectomy and paracolpectomy in order to save the autonomic nerve plexus from dissection to avoid this type of bladder morbidity [1415].…”