Abstract
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.
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Acknowledgement
This study was funded in part through the NIH/NCI Support Grant P30 CA008748 (Nadeem R. Abu-Rustum).
Disclosure
Denis Querleu received travel expenses for the 2014 IGCS meeting (Melbourne) from Karl Storz GmBH. He has consulted for Roche Inc. Other authors declares no conflicts of interest.
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Fig. S1
Medial paravesical space developed medial to the lateral ligament of the bladder. Supplementary material 1 (PPT 283 kb)
Fig. S2
Medial pararectal space artificially created lateral to the rectal pillar and mesorectum, medial to the autonomic nerves. Supplementary material 2 (PPT 274 kb)
Fig. S3
Medial and lateral part of the paracervix. Courtesy of Pr. Brigitte Mauroy, Institute of Anatomy, University of Lille, France. *From Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9:297–303. Supplementary material 3 (PPT 669 kb)
Fig. S4
Resection of paracervix at the ureter. The caudal limit must not involve the inferior hypogastric plexus. Supplementary material 4 (PPT 1375 kb)
Fig. S5
Type C2 resection showing complete dissection of the ureter from ventral parametria. Supplementary material 5 (PPT 2126 kb)
Fig. S6
Type C2 resection showing medial pararectal, lateral pararectal, and lateral paravesical spaces unified by transection of pelvic attachment of the paracervix together with splanchnic nerves in the caudal part. Supplementary material 6 (PPT 326 kb)
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Querleu, D., Cibula, D. & Abu-Rustum, N.R. 2017 Update on the Querleu–Morrow Classification of Radical Hysterectomy. Ann Surg Oncol 24, 3406–3412 (2017). https://doi.org/10.1245/s10434-017-6031-z
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DOI: https://doi.org/10.1245/s10434-017-6031-z