Abstract
In this issue of the journal, Höckel et al. [ [1] Höckel M. Local spread of cervical cancer revisited: a clinical and pathological pattern analysis. Gyncol Oncol. 2010; 117: 401-408 Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar ] provide further evidence for what they describe as an “alternative concept of local tumor spread” in patients with cervical cancer. This concept suggests that cervical cancer spreads via embryologic compartments. This understanding of the progression of cervical cancer forms the basis of the authors' surgical management of both primary and recurrent disease. The authors use a detailed analysis of the embryologic development of the reproductive organs as indirect justification for their approach, which expands on their previous work describing nerve-sparing radical hysterectomy and total mesometrial resection (TMMR) and laterally extended endopelvic resection (LEER) [ 2 Höckel M.H.L. Manthey N. Braumann U. Wolf U. Teichmann G. Frauenschlager K. Dornhofer N. Einenkel J. Resection of the embryologically defined uterovaginal (Mullerian) compartment and pelvic control in patients with cervical cancer: a prospective analysis. Lancet. 2009; 10: 683-692 Abstract Full Text Full Text PDF Scopus (131) Google Scholar , 3 Höckel M.H.L.C. Fritsch H. Association between the mesenchymal compartment of uterovaginal organogenesis and local tumour spread in stage IB–IIB cervical carcinoma: a prospective study. Lancet. 2005; 6: 751-756 Abstract Full Text Full Text PDF Scopus (117) Google Scholar , 4 Dornhofer N.H.M. New developments in the surgical therapy of cervical carcinoma. Ann N Y Acad Sci. 2008; 1138: 233-252 Crossref PubMed Scopus (24) Google Scholar , 5 Höckel M.H.L.C. Hentschel B. Hockel S. Naumann G. Total mesometrial resection: high resolution nerve-sparing radical hysterectomy based on developmentally defined surgical anatomy. Int J Gynecol Cancer. 2003; 13: 791-803 Crossref PubMed Scopus (115) Google Scholar , 6 Höckel M. Laterally extended endopelvic resection: surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies. Am J Obstet Gynecol. 1999; 180: 306-312 Abstract Full Text Full Text PDF PubMed Scopus (63) Google Scholar , 7 Höckel M. Ultra-radical compartmentalized surgery in gynaecological oncology. Eur J Gynaec Oncol. 2006; 32: 859-865 Scopus (34) Google Scholar , 8 Höckel M.S.K. Hamm H. Knapstein P.G. Hohenfellner R. Rossler H.P. Five-year experience with combined operative and radiotherapeutic treatment of recurrent gynecologic tumors infiltrating the pelvic wall. Cancer. 1996; 77: 1918-1933 Crossref PubMed Scopus (86) Google Scholar , 9 Höckel M.D.N. Pelvic exenteration for gynaecological tumours: achievements and unanswered questions. Lancet. 2006; 7: 837-847 Abstract Full Text Full Text PDF Scopus (151) Google Scholar ]. Höckel et al. advocate that radical and ultra radical surgery for cervical cancer should be determined by the cancer's relationship to the boundaries of embryologic compartments as long as the tumor is confined to those compartments; they say, the risk of relapse is low, and adjuvant therapy is not needed if the margins are negative at any distance.
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