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.
Highlights
Radical hysterectomy has been developed as a standard treatment in Stage I and II cervical cancers with and without adjuvant therapy
First evidence for the functionality of this theory concerning the paramesonephric-mesonephricMüllerian tubercle complex in cervical cancer has been shown for cervical cancer with respect to local tumor control following total mesometrial resection (TMMR) without any adjuvant radiotherapy [9,10] and with respect to the pattern analysis of local tumor spread in advanced and recurrent disease [11]
We recently reported on the technique of therapeutic pelvic and paraaortic lymphadenectomy transferred to robotic surgery in genital cancer with special respect to uterine cancer
Summary
Radical hysterectomy has been developed as a standard treatment in Stage I and II cervical cancers with and without adjuvant therapy. First evidence for the functionality of this theory concerning the paramesonephric-mesonephricMüllerian tubercle complex in cervical cancer has been shown for cervical cancer with respect to local tumor control following total mesometrial resection (TMMR) without any adjuvant radiotherapy [9,10] and with respect to the pattern analysis of local tumor spread in advanced and recurrent disease [11]. It has to be questioned whether the confirmation of these findings could fundamentally change the classification of radical hysterectomy and the indication for adjuvant radiotherapy [12]. With respect to regional spread data and pelvic therapeutic lymphadenectomy (tLNE), they were systematically analyzed and assigned to ontogenetic lymphatic compartments, which may be classified as external iliac nodes, paravisceral nodes, common iliac nodes and presacral nodes [13]
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