International expert consensus on the surgical anatomic classification of radical hysterectomies

Abstract

The anatomical descriptions and extents of radical hysterectomy often vary across the literature and operative reports worldwide. The same nomenclature is often used to describe varying procedures, and different nomenclature is often used to describe the same procedure, despite the availability of guideline and classification systems. This makes it difficult to interpret retrospective surgical reports, analyze surgical databases, understand technique descriptions, and interpret the findings of surgical studies. In collaboration with international experts in gynecologic oncology, the purpose of this study was to establish a consensus in defining and interpreting the 2017 updated Querleu-Morrow classification of radical hysterectomies. The anatomical templates of type A, B, and C radical hysterectomy were documented by a set of 13 images taken at the time of cadaver dissection An online survey related to radical hysterectomy nomenclature and definitions/descriptions of associated procedures was circulated across international experts on radical hysterectomy. A three-step modified Delphi method was used to establish consensus. Image legends were amended according to the experts' responses and then redistributed as part of a second round of the survey. Consensus was indicated by a "yes" response to a question concerning a specific image. Anyone responding "no" to a question was welcome to comment and provide justification. A final set of images and legends were established to anatomically illustrate and define/describe a lateral, ventral, and dorsal excision of the tissues surrounding the cervix. In all there were 13 questions to reviews. Twenty nine experts completed the whole process. Final consensus exceeded 90 % for all questions but one (86%). Questions with relatively lower consensus rates concerned the definitions of types A and B2 radical hysterectomy, which were the main innovations of the 2017 updated version of the 2008 Querleu-Morrow classification. Questions with the highest consensus rates concerned the definitions of types B1 and C, which are the most frequently performed radical hysterectomies. The 2017 version of the Querleu-Morrow classification proved to be a robust tool for defining and describing the extent of radical hysterectomies, with a high level of consensus among international experts in gynecologic oncology. Knowledge and implementation of the exact definitions of hysterectomy radicality are imperative in clinical practice and clinical research.