Total mesometrial resection: High resolution nerve-sparing radical hysterectomy based on developmentally defined surgical anatomy

Abstract

Total mesometrial resection (TMMR) is characterized by: i) the en bloc resection of the uterus, proximal vagina, and mesometrium as a developmentally defined entity; ii) transection of the rectouterine dense subperitoneal connective tissue above the level of the exposed inferior hypogastric plexus; and iii) extended pelvic/periaortic lymph node dissection preserving the superior hypogastric plexus. Since July 1998 we have studied prospectively the outcome in patients treated with TMMR for cervical carcinoma FIGO stages IB, IIA, and selected IIB. By July 2002, 71 patients with cervical cancer stages pT1b1 (n = 48), pT1b2 (n = 8), pT2a (n = 3), pT2b (n = 12) had undergone TMMR without adjuvant radiation. Fifty-four percent of the patients exhibited histopathologic high risk factors. At a median observation period of 30 months (9–57 months) two patients relapsed locally, two patients developed pelvic and distant recurrences and two patients only distant recurrences. Three patients died from their disease. Grade 1 and 2 complications occurred in 20 patients, no patient had grade 3 or 4 complications. No severe long-term impairment of pelvic visceral functions related to autonomic nerve damage was detected. Based on these preliminary results, we believe TMMR achieves a promising therapeutic index by providing a high probability of locoregional control at minimal short and long-term morbidity.

Up-to-date management of lymph node metastasis and the role of tailored lymphadenectomy in cervical cancer

“…Recent attempts to avoid this complication with nerve-sparing surgical techniques have signifi cantly decreased the risk of this adverse effect. [6][7][8] Radical hysterectomy mentioned in the literature includes modifi ed radical hysterectomy (type 2 hysterectomy), Wertheim-Meigs radical hysterectomy (type 3 hysterectomy), and Okabayashi radical hysterectomy (type 4 hysterectomy). The thoroughness of lymphadenectomy, represented by the number of nodes removed, is suggested to correlate with patient survival and varies signifi cantly among studies.…”

The Swift operation: a modification of the Leiden nerve-sparing radical hysterectomy

“…The Swift operation is inspired by and resembles the total mesometrial resection (TMMR) described by Höckel et al [16]. This operation is based on the hypothesis that the local spread of cervical cancer cells is not a random process, but is guided by positional information within a defined permissive area.…”

Staging und Therapie des Zervixkarzinoms

“…Sie ist Ausdruck eines fortschreitenden Verständ-nisses der Tumorbiologie, der operativen Möglichkeiten und einer auf das individuelle Erkrankungsbild maßge-schneiderten Therapie. Durch die Arbeiten von Michael Höckel et al [4,5] sind die embryonalen Kompartimente in den Fokus gerückt und wollen in einer Operationsklassifikation berücksichtigt sein. Querleu u. Morrow [6] haben kürzlich eine Klassifikation vorgestellt, die sich auf die Ergebnisse eines Expertentreffens im Jahr 2007 stützt.…”