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Neue Konzepte für die operative Therapie des Zervixkarzinoms

New concepts for surgical therapy of cervical carcinoma

  • Schwerpunkt: Zervixpathologie
  • Published:
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Zusammenfassung

Der abdominalen radikalen Hysterektomie (Wertheim-Operation) als derzeitigem Standard der operativen Therapie des Zervixkarzinoms liegen historische Vorstellungen über die Anatomie des weiblichen Beckens und die lokale Tumorausbreitung zugrunde. Die Wertheim-Operation führt — je nach individueller Radikalität des Eingriffs — zur Schädigung essenzieller, nicht tumorinvolvierter Strukturen, u. a. der autonomen Beckennerven. Trotz ihrer vermeintlichen Radikalität muss sie bei histopathologischem Nachweis von Risikofaktoren mit einer adjuvanten Strahlentherapie kombiniert werden, um eine akzeptable lokale Tumorkontrolle zu erzielen. Die totale mesometriale Resektion (TMMR) setzt aus der Entwicklungsbiologie abgeleitete Vorstellungen über die Beckenanatomie und die lokale Tumorausbreitung in ein Radikalitätsprinzip um, das bei völligem Verzicht auf eine adjuvante Strahlentherapie eine sehr hohe lokoregionäre Rezidivfreiheit bei minimaler behandlungsbedingter Morbidität erreicht.

Abstract

Abdominal radical hysterectomy (Wertheim operation) is the current standard of surgical therapy of cervical carcinoma. It is based on historical concepts of female pelvic anatomy and locoregional tumor spread. This surgical therapy — depending on the individual radicality of the operation — leads to damage of essential structures not involved by the tumor, e.g. the autonomic pelvic nerves. Despite of its supposed radicality the Wertheim operation has to be combined with adjuvant radiotherapy in case of histopathological high risk factors to reach acceptable rates of tumor control. The total mesometrial resection (TMMR) uses new insights in pelvic anatomy and local tumor spread derived from developmental biology for a new concept of radicality achieving a high regional control rate with minimal treatment-related morbidity without adjuvant radiotherapy.

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Danksagung

Der Autor dankt seinen Mitarbeitern Dr. Jens Einenkel, Susanne Schrey, Katja Schmidt und Prof. Dr. Lars-Christian Horn, Institut für Pathologie, für wichtige Beiträge zum TMMR-Projekt.

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Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

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Authors and Affiliations

  1. Universitätsfrauenklinik Leipzig

    M. Höckel

  2. Universitätsfrauenklinik Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig

    M. Höckel

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  1. M. Höckel
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Correspondence to M. Höckel.

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Höckel, M. Neue Konzepte für die operative Therapie des Zervixkarzinoms. Pathologe 26, 276–282 (2005). https://doi.org/10.1007/s00292-005-0762-5

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  • DOI: https://doi.org/10.1007/s00292-005-0762-5

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