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Modified Radical Hysterectomy

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Surgery for Gynecologic Cancer

Part of the book series: Comprehensive Gynecology and Obstetrics ((CGO))

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Abstract

Modified radical hysterectomy (MRH) is thought to be equivalent to class II (Piver classification) or type B (Querleu classification) radical hysterectomy (RH) and identical to the original method of the Wertheim operation. MRH is a method of hysterectomy defined as being intermediate between simple hysterectomy and RH and enabling almost full preservation of the pelvic splanchnic nerves and hypogastric plexus. This surgical procedure entails the cutting of the anterior leaf, not the posterior one, of the vesicouterine ligament of the uterus. The ureter is mobilized laterally, part of the parametrial tissue is transected at the level of the ureteral tunnel, and at least 10 mm of the vaginal wall from the uterine cervix is removed. The indication of MRH (with pelvic lymphadenectomy) in cervical cancer is International Federation of Gynecology and Obstetrics stage IA1 with lymphovascular space invasion or stage IA2. MRH is associated with a very low (≤1%) rate of significant postoperative complications, and compared with RH, it reduces the rate of adverse effects on the urinary tract, such as fistula formation and severe voiding dysfunction. The mortality rate for those undergoing this procedure is 0.4–0.5%. The possibility of MRH for low-risk FIGO stage IB1 patients has been considered, and clinical trials are ongoing.

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References

  1. Wertheim E. Die erweiterte abdominale Operation bei Carcinoma colli Uteri (auf Grund von 500 Fallen). Berlin: Urban & Schwarzenberg; 1911.

    Google Scholar 

  2. Wertheim E. The extended abdominal operation for carcinoma uteri (based on 500 operative cases). Am J Obstet Dis Women Child. 1912;66:169–232.

    Google Scholar 

  3. Latzko W, Schiffmann J. Klinisches und Anatomisches zur Radikaloperation des Geba¨rmutterkrebses (nach einem am 24. Juni 1919 gehaltenen Vortrag). Diskussinsbemerkungen, Weibel W und Wertheim E Zbl Gyna¨k. 1919;43:715–9.

    Google Scholar 

  4. Okabayashi H. Radical abdominal hysterectomy for cancer of the cervix uteri, modification of the Takayama operation. Surg Gynecol Obstet. 1921;33:335–41.

    Google Scholar 

  5. Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol. 1974;44(2):265–72.

    CAS  PubMed  Google Scholar 

  6. Kobayashi T. Abdominal radical hysterectomy with pelvic lymphadenectomy for cancer of the cervix. Tokyo: Nanzando; 1961.

    Google Scholar 

  7. Yabuki Y, Asamoto A, Hoshiba T, Nishimoto H, Satou N. A new proposal for radical hysterectomy. Gynecol Oncol. 1996;62(3):370–8. https://doi.org/10.1006/gyno.1996.0251.

    Article  CAS  PubMed  Google Scholar 

  8. Sakuragi N, Todo Y, Kudo M, Yamamoto R, Sato T. A systematic nerve-sparing radical hysterectomy technique in invasive cervical cancer for preserving postsurgical bladder function. Int J Gynecol Cancer. 2005;15(2):389–97. https://doi.org/10.1111/j.1525-1438.2005.15236.x.

    Article  CAS  PubMed  Google Scholar 

  9. Fujii S. Anatomic identification of nerve-sparing radical hysterectomy: a step-by-step procedure. Gynecol Oncol. 2008;111(2 Suppl):S33–41. https://doi.org/10.1016/j.ygyno.2008.07.026.

    Article  PubMed  Google Scholar 

  10. Trimbos JB, Maas CP, Deruiter MC, Peters AA, Kenter GG. A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients. Int J Gynecol Cancer. 2001;11(3):180–6.

    Article  CAS  PubMed  Google Scholar 

  11. Raspagliesi F, Ditto A, Fontanelli R, Solima E, Hanozet F, Zanaboni F, et al. Nerve-sparing radical hysterectomy: a surgical technique for preserving the autonomic hypogastric nerve. Gynecol Oncol. 2004;93(2):307–14. https://doi.org/10.1016/j.ygyno.2004.01.048.

    Article  PubMed  Google Scholar 

  12. Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9(3):297–303. https://doi.org/10.1016/s1470-2045(08)70074-3.

    Article  PubMed  Google Scholar 

  13. Hoskins WJ, Ford JH Jr, Lutz MH, Averette HE. Radical hysterectomy and pelvic lymphadenectomy for the management of early invasive cancer of the cervix. Gynecol Oncol. 1976;4(3):278–90.

    Article  CAS  PubMed  Google Scholar 

  14. Webb MJ, Symmonds RE. Wertheim hysterectomy: a reappraisal. Obstet Gynecol. 1979;54(2):140–5.

    CAS  PubMed  Google Scholar 

  15. Underwood PB Jr, Wilson WC, Kreutner A, Miller MC 3rd, Murphy E. Radical hysterectomy: a critical review of twenty-two years’ experience. Am J Obstet Gynecol. 1979;134(8):889–98.

    Article  PubMed  Google Scholar 

  16. Powell JL, Burrell MO, Franklin EW 3rd. Radical hysterectomy and pelvic lymphadenectomy. Gynecol Oncol. 1981;12(1):23–32.

    Article  CAS  PubMed  Google Scholar 

  17. Artman LE, Hoskins WJ, Bibro MC, Heller PB, Weiser EB, Barnhill DR, et al. Radical hysterectomy and pelvic lymphadenectomy for stage IB carcinoma of the cervix: 21 years experience. Gynecol Oncol. 1987;28(1):8–13.

    Article  CAS  PubMed  Google Scholar 

  18. Kenter GG, Ansink AC, Heintz AP, Aartsen EJ, Delemarre JF, Hart AA. Carcinoma of the uterine cervix stage I and IIA: results of surgical treatment: complications, recurrence and survival. Eur J Surg Oncol. 1989;15(1):55–60.

    CAS  PubMed  Google Scholar 

  19. Christopherson WM, Scott MA. Trends in mortality from uterine cancer in relation to mass screening. Acta Cytol. 1977;21(1):5–9.

    CAS  PubMed  Google Scholar 

  20. Kim K, Rigal RD, Patrick JR, Walters JK, Bennett A, Nordin W, et al. The changing trends of uterine cancer and cytology: a study of morbidity and mortality trends over a twenty year period. Cancer. 1978;42(5):2439–49.

    Article  CAS  PubMed  Google Scholar 

  21. Eddy DM. Screening for cervical cancer. Ann Intern Med. 1990;113(3):214–26.

    Article  CAS  PubMed  Google Scholar 

  22. Lees BF, Erickson BK, Huh WK. Cervical cancer screening: evidence behind the guidelines. Am J Obstet Gynecol. 2016;214(4):438–43. https://doi.org/10.1016/j.ajog.2015.10.147.

    Article  PubMed  Google Scholar 

  23. Jr NJ. Atlas of radical pelvic surgery. New York: Appelton-Century-Crofts; 1969.

    Google Scholar 

  24. Magrina JF, Goodrich MA, Weaver AL, Podratz KC. Modified radical hysterectomy: morbidity and mortality. Gynecol Oncol. 1995;59(2):277–82. https://doi.org/10.1006/gyno.1995.0022.

    Article  CAS  PubMed  Google Scholar 

  25. Yang YC, Chang CL. Modified radical hysterectomy for early Ib cervical cancer. Gynecol Oncol. 1999;74(2):241–4. https://doi.org/10.1006/gyno.1999.5434.

    Article  CAS  PubMed  Google Scholar 

  26. Landoni F, Maneo A, Cormio G, Perego P, Milani R, Caruso O, et al. Class II versus class III radical hysterectomy in stage IB-IIA cervical cancer: a prospective randomized study. Gynecol Oncol. 2001;80(1):3–12. https://doi.org/10.1006/gyno.2000.6010.

    Article  CAS  PubMed  Google Scholar 

  27. Cervical Cancer Guideline (version 1. 2017) [database on the Internet]. NCCN Clinical Practice Guidelines in Oncology. 2017.

    Google Scholar 

  28. Ebina Y, Yaegashi N, Katabuchi H, Nagase S, Udagawa Y, Hachisuga T, et al. Japan Society of Gynecologic Oncology guidelines 2011 for the treatment of uterine cervical cancer. Int J Clin Oncol. 2015;20(2):240–8. https://doi.org/10.1007/s10147-015-0806-7.

    Article  PubMed  Google Scholar 

  29. Sevin BU, Nadji M, Averette HE, Hilsenbeck S, Smith D, Lampe B. Microinvasive carcinoma of the cervix. Cancer. 1992;70(8):2121–8.

    Article  CAS  PubMed  Google Scholar 

  30. Takeshima N, Yanoh K, Tabata T, Nagai K, Hirai Y, Hasumi K. Assessment of the revised International Federation of Gynecology and obstetrics staging for early invasive squamous cervical cancer. Gynecol Oncol. 1999;74(2):165–9. https://doi.org/10.1006/gyno.1999.5473.

    Article  CAS  PubMed  Google Scholar 

  31. Elliott P, Coppleson M, Russell P, Liouros P, Carter J, MacLeod C, et al. Early invasive (FIGO stage IA) carcinoma of the cervix: a clinico-pathologic study of 476 cases. Int J Gynecol Cancer. 2000;10(1):42–52.

    Article  PubMed  Google Scholar 

  32. Bouchard-Fortier G, Reade CJ, Covens A. Non-radical surgery for small early-stage cervical cancer. Is it time? Gynecol Oncol. 2014;132(3):624–7. https://doi.org/10.1016/j.ygyno.2014.01.037.

    Article  PubMed  Google Scholar 

  33. Lee JY, Kim HS, Kim K, Chung HH, Kim JW, Park NH, et al. Safety of less aggressive surgery for stage IA1 squamous cell carcinoma of the cervix. J Obstet Gynaecol Res. 2014;40(5):1382–8. https://doi.org/10.1111/jog.12330.

    Article  PubMed  Google Scholar 

  34. van Meurs H, Visser O, Buist MR, Ten Kate FJ, van der Velden J. Frequency of pelvic lymph node metastases and parametrial involvement in stage IA2 cervical cancer: a population-based study and literature review. Int J Gynecol Cancer. 2009;19(1):21–6. https://doi.org/10.1111/IGC.0b013e318197f3ef.

    Article  PubMed  Google Scholar 

  35. Mahawerawat S, Charoenkwan K, Srisomboon J, Khunamornpong S, Suprasert P, Sae-Teng CT. Surgical outcomes of patients with stage IA2 cervical cancer treated with radical hysterectomy. Asian Pac J Cancer Prev. 2013;14(9):5375–8.

    Article  PubMed  Google Scholar 

  36. Qian Q, Yang J, Cao D, You Y, Chen J, Shen K. Analysis of treatment modalities and prognosis on microinvasive cervical cancer: a 10-year cohort study in China. J Gynecol Oncol. 2014;25(4):293–300. https://doi.org/10.3802/jgo.2014.25.4.293.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Yoneda JY, Braganca JF, Sarian LO, Borba PP, Conceicao JC, Zeferino LC. Surgical treatment of microinvasive cervical cancer: analysis of pathologic features with implications on radicality. Int J Gynecol Cancer. 2015;25(4):694–8. https://doi.org/10.1097/igc.0000000000000416.

    Article  PubMed  Google Scholar 

  38. Creasman WT. New gynecologic cancer staging. Gynecol Oncol. 1995;58(2):157–8. https://doi.org/10.1006/gyno.1995.1203.

    Article  CAS  PubMed  Google Scholar 

  39. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet. 2009;105(2):103–4.

    Article  PubMed  Google Scholar 

  40. Pecorelli S, Odicino F. Cervical cancer staging. Cancer J. 2003;9(5):390–4.

    Article  PubMed  Google Scholar 

  41. Siegel CL, Andreotti RF, Cardenes HR, Brown DL, Gaffney DK, Horowitz NS, et al. ACR Appropriateness Criteria(R) pretreatment planning of invasive cancer of the cervix. J Am Coll Radiol. 2012;9(6):395–402. https://doi.org/10.1016/j.jacr.2012.02.021.

    Article  PubMed  Google Scholar 

  42. Patel S, Liyanage SH, Sahdev A, Rockall AG, Reznek RH. Imaging of endometrial and cervical cancer. Insights Imaging. 2010;1(5–6):309–28. https://doi.org/10.1007/s13244-010-0042-7.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Bourgioti C, Chatoupis K, Moulopoulos LA. Current imaging strategies for the evaluation of uterine cervical cancer. World J Radiol. 2016;8(4):342–54. https://doi.org/10.4329/wjr.v8.i4.342.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Fujii S, Takakura K, Matsumura N, Higuchi T, Yura S, Mandai M, et al. Precise anatomy of the vesico-uterine ligament for radical hysterectomy. Gynecol Oncol. 2007;104(1):186–91. https://doi.org/10.1016/j.ygyno.2006.07.041.

    Article  PubMed  Google Scholar 

  45. Photopulos GJ, Zwaag RV. Class II radical hysterectomy shows less morbidity and good treatment efficacy compared to class III. Gynecol Oncol. 1991;40(1):21–4.

    Article  CAS  PubMed  Google Scholar 

  46. Plotti F, Nelaj E, Sansone M, Antonelli E, Altavilla T, Angioli R, et al. Sexual function after modified radical hysterectomy (Piver II/Type B) vs. classic radical hysterectomy (Piver III/Type C2) for early stage cervical cancer. A prospective study. J Sex Med. 2012;9(3):909–17. https://doi.org/10.1111/j.1743-6109.2011.02581.x.

    Article  PubMed  Google Scholar 

  47. Zullo MA, Manci N, Angioli R, Muzii L, Panici PB. Vesical dysfunctions after radical hysterectomy for cervical cancer: a critical review. Crit Rev Oncol Hematol. 2003;48(3):287–93.

    Article  PubMed  Google Scholar 

  48. Michalas S, Rodolakis A, Voulgaris Z, Vlachos G, Giannakoulis N, Diakomanolis E. Management of early-stage cervical carcinoma by modified (type II) radical hysterectomy. Gynecol Oncol. 2002;85(3):415–22. https://doi.org/10.1006/gyno.2002.6633.

    Article  PubMed  Google Scholar 

  49. Kinney WK, Hodge DO, Egorshin EV, 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(1):3–6. https://doi.org/10.1006/gyno.1995.1091.

    Article  CAS  PubMed  Google Scholar 

  50. Covens A, Rosen B, Murphy J, Laframboise S, DePetrillo AD, Lickrish G, et al. How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol. 2002;84(1):145–9. https://doi.org/10.1006/gyno.2001.6493.

    Article  CAS  PubMed  Google Scholar 

  51. Stegeman M, Louwen M, van der Velden J, ten Kate FJ, den Bakker MA, Burger CW, et al. The incidence of parametrial tumor involvement in select patients with early cervix cancer is too low to justify parametrectomy. Gynecol Oncol. 2007;105(2):475–80. https://doi.org/10.1016/j.ygyno.2007.01.016.

    Article  CAS  PubMed  Google Scholar 

  52. Wright JD, Grigsby PW, Brooks R, Powell MA, Gibb RK, Gao F, et al. Utility of parametrectomy for early stage cervical cancer treated with radical hysterectomy. Cancer. 2007;110(6):1281–6. https://doi.org/10.1002/cncr.22899.

    Article  PubMed  Google Scholar 

  53. Frumovitz M, Sun CC, Schmeler KM, Deavers MT, Dos Reis R, Levenback CF, et al. Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer. Obstet Gynecol. 2009;114(1):93–9. https://doi.org/10.1097/AOG.0b013e3181ab474d.

    Article  PubMed  Google Scholar 

  54. Kato T, Takashima A, Kasamatsu T, Nakamura K, Mizusawa J, Nakanishi T, et al. Clinical tumor diameter and prognosis of patients with FIGO stage IB1 cervical cancer (JCOG0806-A). Gynecol Oncol. 2015;137(1):34–9. https://doi.org/10.1016/j.ygyno.2015.01.548.

    Article  PubMed  Google Scholar 

  55. Magrina JF, Goodrich MA, Lidner TK, Weaver AL, Cornella JL, Podratz KC. Modified radical hysterectomy in the treatment of early squamous cervical cancer. Gynecol Oncol. 1999;72(2):183–6. https://doi.org/10.1006/gyno.1998.5245.

    Article  CAS  PubMed  Google Scholar 

  56. Cai HB, Chen HZ, Zhou YF, Lie DM, Hou HY. Class II radical hysterectomy in low-risk IB squamous cell carcinoma of cervix: a safe and effective option. Int J Gynecol Cancer. 2009;19(1):46–9. https://doi.org/10.1111/IGC.0b013e318197f847.

    Article  PubMed  Google Scholar 

  57. Kunieda F, Kasamatsu T, Arimoto T, Onda T, Toita T, Shibata T, et al. Non-randomized confirmatory trial of modified radical hysterectomy for patients with tumor diameter 2 cm or less FIGO Stage IB1 uterine cervical cancer: Japan Clinical Oncology Group Study (JCOG1101). Jpn J Clin Oncol. 2015;45(1):123–6. https://doi.org/10.1093/jjco/hyu168.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan

    Yasuyuki Hirashima, Munetaka Takekuma, Nobutaka Takahashi, Masakazu Abe, Nobuhiro Kado, Yuka Kasamatsu, Ayako Mochizuki & Emi Yoshioka

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  1. Yasuyuki Hirashima
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  2. Munetaka Takekuma
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Correspondence to Yasuyuki Hirashima .

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  1. Department of Obstetrics and Gynecology, School of Medicine, Tokai University, Isehara, Japan

    Mikio Mikami

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Hirashima, Y. et al. (2019). Modified Radical Hysterectomy. In: Mikami, M. (eds) Surgery for Gynecologic Cancer. Comprehensive Gynecology and Obstetrics. Springer, Singapore. https://doi.org/10.1007/978-981-13-1519-0_6

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  • DOI: https://doi.org/10.1007/978-981-13-1519-0_6

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