BACKGROUND: The anatomic 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. OBJECTIVE: 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. STUDY DESIGN: The anatomic templates of type A, B, and C radical hysterectomy were documented through a set of 13 images taken at the time of cadaver dissection. An online survey related to radical hysterectomy nomenclature and definitions or descriptions of the associated procedures was circulated among international experts in radical hysterectomy. A 3-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 defined by a yes response to a question concerning a specific image. Anyone who responded no to a question was welcome to comment and provide justification. A final set of images and legends were compiled to anatomically illustrate and define or describe a lateral, ventral, and dorsal excision of the tissues surrounding the cervix. RESULTS: In total, there were 13 questions to review, and 29 experts completed the whole process. Final consensus exceeded 90% for all questions except 1 (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. CONCLUSION: 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.

Charles University and General University Hospital 1st Faculty of Medicine Prague Czech Republic

Department of Surgery Gynecology Service Memorial Sloan Kettering Cancer Center New York NY

Unit of Gynecologic Oncology ARNAS Civico Di Cristina Benfratelli Department of Health Promotion Mother and Child Care Internal Medicine and Medical Specialties University of Palermo Palermo Italy

UOC Ginecologia Oncologica Dipartimento per la salute della Donna e del Bambino e della Sanità Pubblica Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy

Zobrazit více v PubMed

Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209–49 PubMed

Cibula D, Raspollini MR, Planchamp F, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer – Update 2023. Int J Gynecol Cancer 2023;33:649–666 PubMed PMC

Cibula D, Planchamp F, Fischerova D et al. European Society of Gynaecological Oncology quality indicators for surgical treatment of cervical cancer. Int J Gynecol Cancer 2020;30:3–14 PubMed

https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1426Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol 2008;9:297–303 PubMed

Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol 2008;9:297–303. PubMed

Haibier K, Xu J, Sun C, et al. Global research trends on surgery in uterine cervical neoplasms: a bibliometric analysis via CiteSpace. Research square. 2022. Available at: 10.21203/rs.3.rs-1635222/v1. Accessed October 16, 2023. DOI

Genovese F, Siringo S, Tuscano A, et al. Understanding the limits of parametrial resection in radical hysterectomy: a randomized controlled trial. Prz Menopauzalny 2022;21:10–9. PubMed PMC

Querleu D, Cibula D, Abu-Rustum NR. 2017 update on the Querleu-Morrow classification of radical hysterectomy. Ann Surg Oncol 2017. ;24 :3406–12 PubMed PMC

Querleu D, Bizzarri N, Fanfani F, Fagotti A, Scambia G. Simplified anatomical nomenclature of lateral female pelvic spaces. Int J Gynecol Cancer 2022. ;32 :1983–8 PubMed

Lührs O, Ekdahl L, Geppert B, Lönnerfors C, Persson J. Resection of the upper paracervical lymphovascular tissue should be an integral part of a pelvic sentinel lymph node algorithm in early stage cervical cancer. Gynecol Oncol. 2021:S0090-8258(21)01328-7; PubMed

Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 1974;44:265–272 PubMed

Querleu D, Fanfani F, Fagotti A, Bizzarri N, Scambia G. What is paracervical lymphadenectomy ? Gynecol Oncol Reports 2021;38:100891 PubMed PMC

Querleu D, Leblanc E, 1998. Laparoscopic pelvic lymphadenectomy. In: Sutton C, Diamond M (Eds.), Endoscopic surgery for gynaecologists, 2nd ed. Saunders, London, pp. 407–416.

Querleu D, Narducci F, Poulard V et al. Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: a comparative study. Gynecol Oncology 2002, 85, 154–158 . gyn onc rep 2022 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

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

Piedimonte S, Helpman L, Pond G, Nelson G, Kwon J, Altman A, Feigenberg T, Elit L, Lau S, Sabourin J, Samouelian V, Willows K, Aubrey C, Jang JH, Teo-Fortin LA, Cockburn N, Saunders NB, Shamiya S, Vicus D, Plante M; 4C: Canadian Cervical Cancer Collaborative. Surgical margin status in relation to surgical approach in the management of early-stage cervical Cancer: A Canadian cervical Cancer collaborative (4C) study. Gynecol Oncol1 2023;174:21–27 PubMed

Muallem MZ. A new anatomic and staging-oriented classification of radical hysterectomy. Cancers 2021, 13, 3326. PubMed PMC

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

Sakuragi N, Murakami G, Konno Y, Kaneuchi M, Watari H. Nerve-sparing radical hysterectomy in the precision surgery for cervical cancer. J Gynecol Oncol 2020. ;31 :e49. PubMed PMC

Zapardiel I, Ceccaroni M, Minig L, Halaska MJ, Fujii S. Avascular spaces in radical hysterectomy. Int J Gynecol Cancer 2023;33:285–92 PubMed

Massi G, Savino L, Susini T. Three classes of radical vaginal hysterectomy for the treatment of endometrial and cervical cancer. Am J Obstet Gynecol 1993;175:1576–85 PubMed

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

Lee M, Choi CH, Chun YK, Kim YH, Lee KB, Lee SW, et al. Surgical manual of the Korean Gynecologic Oncology Group: classification of hysterectomy and lymphadenectomy. J Gynecol Oncol 2017;28:e5. PubMed PMC