Abstract
There is an obvious prevalence of disparity in opinions concerning the technique of nerve-sparing radical hysterectomy and its application, despite agreement on the need to spare the pelvic autonomic nerve system during such a radical operation. Understanding the precise three-dimensional anatomy of paracolpium and its close anatomical relationship to the components of the pelvic autonomic nervous system is the key in performing the nerve-sparing radical hysterectomy. A total of 42 consecutive patients with primary cervical cancers, who were operated upon in our institution between January 2017 and June 2019, were analyzed, concerning surgical, urinary functional, and short-term oncologic outcomes. Two thirds of the patients had locally advanced tumors (T > 40 mm or pT ≥ IIA2) with a median tumor size of 44.1 mm. The nerve-sparing radical hysterectomy was combined with the complete recovery of bladder function in 90% of patients directly after surgery and in 97% of patients in the first 2 weeks. The recurrence rate in a median follow-up time of 18 months was 9.5%. The nerve-sparing radical hysterectomy approach, which depends on the comprehensive understanding of the precise entire anatomy of paracolpium, was found to be feasible and applicable, even in locally advanced tumors, with good functional results and convincing short-term oncologic outcomes.
Highlights
In their latest review (2017) [1] on Querleu–Morrow classification of radical hysterectomy (2008) [2], Querleu et al emphasize the appropriation of the nerve-sparing technique to radical hysterectomy type C adapted to the International Federation of Gynecology and Obstetrics (FIGO) stage IB1 with deep stromal invasion and IB2-IIA or early IIB cervical cancers
Some investigators, who claimed that nerve-sparing radical hysterectomy has to be restricted only to small tumors in early-stage cervical cancers [4,5,6,7], ignored that the fact that technique was designed to deal with vesicovaginal ligament with sparing the bladder branches of inferior hypogastric plexus
We describe our technique for nerve-sparing radical hysterectomy
Summary
In their latest review (2017) [1] on Querleu–Morrow classification of radical hysterectomy (2008) [2], Querleu et al emphasize the appropriation of the nerve-sparing technique to radical hysterectomy type C adapted to the International Federation of Gynecology and Obstetrics (FIGO) stage IB1 (the old version from 2008 [3]) with deep stromal invasion and IB2-IIA or early IIB cervical cancers This has not been defined arbitrarily, but rather because large and/or deep-infiltrating tumors will not be sufficiently operated on without a total resection of the vesicouterine (ventral parametrium) and vesicovaginal ligaments (ventral paracolpium) combined with a resection of adjusted length of the vaginal vault and its surrounding paracolpium. We report the urologic functional and short-term oncologic outcomes of this technique
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