The twenty-first century role of Piver-Rutledge type III radical hysterectomy and FIGO stage IA, IB1, and IB2 cervical cancer in the era of robotic surgery: a personal perspective

Abstract

Type III radical hysterectomy reported in 1974 by Piver, Rutledge, and Smith is considered worldwide by many as the standard surgical therapy for invasive cervical carcinoma stage IB and IIA. With the increasing number of robotic surgeries being performed for early stage cervical cancer worldwide, the purpose of the paper is to present our personal perspective of the 21st century role of Piver-Rutledge type III radical hysterectomy for stage IB cervical cancer in the era of robotic surgery using the da Vinci robot.

Can laparoscopic radical hysterectomy be a standard surgical modality in stage IA2–IIA cervical cancer?

“…Under general anesthesia, patients were placed in a lithotomic position and pelvic examinations were performed. Study patients underwent Piver type III hysterectomy using the port-placement system that we previously reported [13,14]. First, we performed laparoscopic inspection and palpation of pelvic and para-aortic lymph nodes and frozen-section analyses on suspicious enlarged lymph nodes.…”

Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB–IIA Cervical Cancer

“…1 Parametrial involvement (PMI), lymph node metastasis, and positive surgical margins are prognostic factors associated with recurrence and established indications for adjuvant chemotherapy and pelvic radiotherapy following surgery. 2 If PMI is suspected before the treatment, only the Japanese guideline and some centers from Germany recommend surgery, whereas guidelines from the United States and European countries other than Germany recommend concurrent chemoradiation instead of surgery.…”

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

“…The Piver-Rutlege-Smith classification published in 1974 has achieved popularity [45]. However, several limitations, including inconsistencies in terminology, drawbacks associated with a uterocentric concept, exclusion of nerve-sparing and fertility-preserving techniques, and difficulties adapting the guidelines to advances in vaginal, laparoscopic, or robotic surgery, makes continued use of the classification challenging.…”

“…† It is similar to type I of the “Piver-Rutledge-Smith (PRS) classification” [45]. ‡ (T) means trachelectomy (cervicectomy).…”