BACKGROUND: One of the most important principles in modern cervical cancer surgery is the concept of tailoring surgical radicality. In practice, this means abandoning the "one-fits-all" concept in favor of tailored operations. The term "radical hysterectomy" is used to describe many different procedures, each with a different degree of radicality. Anatomic structures are subjected to artificial dissection artifacts, as well as different interpretations and nomenclatures. This study aimed to refine and standardize the principles and descriptions of the different classes of radical hysterectomy as defined in the Querleu-Morrow classification and to propose its universal applicability. METHODS: All three authors independently examined the current literature and undertook a critical assessment of the original classification. Images and pathologic slides demonstrating different types of radical hysterectomy were examined to document a consensual vision of the anatomy. The Cibula 3-D concept also was included in this update. RESULTS: The Querleu-Morrow classification is based on the lateral extent of resection. Four types of radical hysterectomy are described, including a limited number of subtypes when necessary. Two major objectives remain constant: excision of central tumor with clear margins and removal of any potential sites of nodal metastasis. CONCLUSION: Studies evaluating radicality in the surgical management of cervical cancer should be based on precise, universally accepted descriptions. The authors' updated classification presents standardized, universally applicable descriptions of different types of hysterectomies performed worldwide, categorized according to degree of radicality, independently of theoretical considerations.

Charles University Prague Czech Republic

Department of Surgery Institut Bergonié Bordeaux France

Department of Surgery Memorial Sloan Kettering Cancer Center New York NY USA

Weill Cornell Medical School New York NY USA

Zobrazit více v PubMed

Landoni F, Bocciolone L, Perego P, Maneo A, Bratina G, Mangioni C. Cancer of the cervix, FIGO stages IB and IIA: patterns of local growth and paracervical extension. Int J Gynecol Cancer. 1995;5:329–34. PubMed

Kinney WK, Hodge DO, Edward V, Egorshin MD, Ballard DJ, Podratz KC. Identification of a low-risk subset of patients with stage IB invasive squamous cancer of the cervix possibly suited to less radical surgical treatment. Gynecol Oncol. 1995;57:3–6. PubMed

Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9:297–300. PubMed

NCCN Clinical Practice Guidelines in Oncology: Cervical Cancer. Version 1 2017. Accessed 19 October 2016 at NCCN.org.

Cibula D, Abu-Rustum NR, Benedetti-Panici P, Köhler C, Raspagliesi F, Querleu D, Morrow CP. New classification system of radical hysterectomy: emphasis on a three-dimensional anatomic template for parametrial resection. Gynecol Oncol. 2011;122:264–8. PubMed

Whitmore I. Terminologia anatomica: new terminology for the new anatomist. Anat Rec. 1999;257:50–3. PubMed

Ercoli A, Delmas V, Fanfani F, Gadonneix P, Ceccaroni M, Fagotti A, et al. Terminologia Anatomica versus unofficial descriptions and nomenclature of the fasciae and ligaments of the female pelvis: a dissection-based comparative study. Am J Obstet Gynecol. 2005;193:1565–73. PubMed

Höckel M, Horn LC, Fritsch H. Association between the mesenchymal compartment of uterovaginal organogenesis and local tumor spread in stage IB-IIB cervical carcinoma: a prospective study. Lancet Oncol. 2005;6:751–6. PubMed

Fujii S, Tanakura K, Matsumura N, Higuchi T, Yura S, Mandai M, Baba T. Precise anatomy of the vesico-uterine ligament for radical hysterectomy. Gynecol Oncol. 2007;104:186–91. PubMed

Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Satou N. A new proposal for radical hysterectomy. Gynecol Oncol. 1996;62:370–8. PubMed

Palfalvi L, Ungar L. Laterally extended parametrectomy (LEP), the technique for radical pelvic sidewall dissection: feasibility, technique, and results. Int J Gynecol Cancer. 2003;13:914–7. PubMed

Höckel M, Konerding MA, Heussel CP. Liposuction-assisted nerve-sparing extended radical hysterectomy: oncologic rationale, surgical anatomy, and feasibility study. Am J Obstet Gynecol. 1998;178:971–6. PubMed

Querleu D, Narducci F, Poulard V, Lacaze S, Occelli B, Leblanc E, Cosson M. Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: a comparative study. Gynecol Oncol. 2002;85:154–8. PubMed

Kyo S, Mizumoto Y, Takakura M, et al. Nerve-sparing abdominal radical trachelectomy: a novel concept to preserve uterine branches of pelvic nerves. Eur J Obstet Gynecol Reprod Biol. 2015;193:5–9. PubMed

Kimmig R, Aktas B, Buderath P, Rusch P, Heubner M. Intra-operative navigation in robotically assisted compartmental surgery of uterine cancer by visualisation of embryologically derived lymphatic networks with indocyanine-green (ICG). J Surg Oncol. 2016;113:554–9. PubMed PMC

Höckel M. Laterally extended endopelvic resection: surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies. Am J Obstet Gynecol. 1999;180:306–12. PubMed

Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol. 1974;44:265–72. PubMed

Trimbos JB. TNM-like classification of radical hysterectomy. Gynecol Oncol. 2009;113:397–8. PubMed

Benedetti-Panici P, Scambia G, Baiocchi G, Maneschi F, Greggi S, Mancuso S. Radical hysterectomy: a randomized study comparing two techniques for resection of the cardinal ligament. Gynecol Oncol. 1993;50:226–31. PubMed

Landoni F, Maneo A, Zapardiel I, Zanagnolo V, Mangioni C. Class I versus class III radical hysterectomy in stage IB1-IIA cervical cancer: a prospective randomized study. Eur J Surg Oncol. 2012;38:203–9. PubMed

Girardi F, Lichtenegger W, Tamussino K, Haas J. The importance of parametrial lymph nodes in the treatment of cervical cancer. Gynecol Oncol. 1989;34:206–11. PubMed

Benedetti-Panici P, Maneschi F, D’Andrea G, et al. Early cervical carcinoma: the natural history of lymph node involvement redefined on the basis of thorough parametrectomy and giant section study. Cancer. 2000;88:2267–74. PubMed

Ultrasound assessment of the pelvic sidewall: methodological consensus opinion

International expert consensus on the surgical anatomic classification of radical hysterectomies

Survival associated with extent of radical hysterectomy in early-stage cervical cancer: a subanalysis of the Surveillance in Cervical CANcer (SCCAN) collaborative study

Role of adjuvant therapy in intermediate-risk cervical cancer patients - Subanalyses of the SCCAN study

Association of Hospital Surgical Volume With Survival in Early-Stage Cervical Cancer Treated With Radical Hysterectomy

Stratification of lymph node metastases as macrometastases, micrometastases, or isolated tumor cells has no clinical implication in patients with cervical cancer: Subgroup analysis of the SCCAN project

Post-recurrence survival in patients with cervical cancer

The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer

Tumour-free distance: a novel prognostic marker in patients with early-stage cervical cancer treated by primary surgery

Micrometastases in Sentinel Lymph Nodes Represent a Significant Negative Prognostic Factor in Early-Stage Cervical Cancer: A Single-Institutional Retrospective Cohort Study

Surgical treatment of "intermediate risk" lymph node negative cervical cancer patients without adjuvant radiotherapy-A retrospective cohort study and review of the literature