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Totale mesometriale Resektion (TMMR)

Total mesometrial resection (TMMR)

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Der Gynäkologe Aims and scope

Zusammenfassung

Der abdominalen radikalen Hysterektomie (Wertheim-Operation), dem derzeitigen Standard der operativen Therapie des Zervixkarzinoms, liegen historische Vorstellungen über die Anatomie des weiblichen Beckens und die lokale Turmorausbreitung zugrunde. Die totale mesometriale Resektion (TMMR) repräsentiert ein neues onkologische Radikalitätsprinzip auf entwicklungsbiologischer Grundlage: die Resektion eines malignen Tumors in den Grenzen der morphogenetischen Einheit seiner Entstehung. Die für die lokale Ausbreitung des Zervixkarzinoms relevante uterovaginale morphogenetische Einheit kann aus der Embryonal- und Fetalentwicklung abgeleitet werden. Anatomische Strukturen, die nicht zu dieser Einheit gehören, z. B. autonome Nerven und Blutgefäße der Harnblase, können trotz der räumlichen Nähe zum Tumor in situ belassen werden. In Kombination mit einer nervenschonenden therapeutischen Lymphonodektomie erreicht die TMMR ohne adjuvante Strahlentherapie eine sehr hohe lokoregionäre Rezidivfreiheit bei vergleichsweise geringer behandlungsbedingter Morbidität.

Abstract

Radical abdominal hysterectomy (Wertheim operation), the current standard of surgical therapy of cervical carcinoma, is based on historical concepts of female pelvic anatomy and locoregional tumor spread. Total mesometrial resection (TMMR) uses new insights in pelvic anatomy and local tumor spread that are derived from developmental biology for a new concept of radicality: the resection of a malignant tumor within the borders of the morphogenetic unit of its origin. The uterovaginal morphogenetic unit relevant for the local spread of cervical carcinoma can be deduced from embryologic and fetal development. Anatomic structures that do not belong to that tissue unit, such as autonomic nerves and blood vessels of the urinary bladder, can be left in situ despite close proximity to the tumor. In combination with a nerve-sparing therapeutic lymph node dissection, TMMR achieves a high regional control rate with minimal treatment-related morbidity without adjuvant radiotherapy.

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Danksagung

Der Autor dankt seinen Mitarbeitern an der Universitätsfrauenklinik Leipzig, Dr. Jens Einenkel, Gero Teichmann, Katja Schmidt, und Prof. Dr. Lars-Christian Horn, Institut für Pathologie der Universität Leipzig, für wichtige Beiträge zum TMMR-Projekt.

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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  1. Frauenklinik, Frauen- und Kinderzentrum des Universitätsklinikums, Liebigstraße 20a, 04103, Leipzig, Deutschland

    M. Höckel

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Correspondence to M. Höckel.

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Höckel, M. Totale mesometriale Resektion (TMMR). Gynäkologe 41, 361–368 (2008). https://doi.org/10.1007/s00129-008-2133-9

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  • DOI: https://doi.org/10.1007/s00129-008-2133-9

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