Totale mesometriale Resektion: Nervenschonende erweitert radikale abdominale Hysterektomie

Zusammenfassung

Die totale mesometriale Resektion (TMMR) ist die erste radikale Hysterektomietechnik, bei der alle operativen Teilschritte durch anatomische Leitstrukturen definiert sind. Mit diesem abdominalen Operationsverfahren wird eine maximale Resektion des onkologisch bedeutsamen Mesometriums mit minimaler Gewebetraumatisierung bei weitgehendem Erhalt der autonomen Versorgung der viszeralen und parietalen Beckenfunktion erreicht. Die pelvine und paraaortale Lymphonodektomie bezieht auch die lateral und dorsal der großen Gefäße lokalisierten Lymphknoten ein. In einer prospektiven multidimensionalen Studie wird derzeit geprüft, ob mit der TMMR der therapeutische Index (Tumorfreiheit/Funktionseinschränkung) der operativen Behandlung des Zervixkarzinoms, insbesondere bei Vorliegen ungünstiger Prognosefaktoren, verbessert werden kann.

Total mesometrial resection: Nerve-sparing extended radical abdominal hysterectomy

Summary

The total mesometrial resection (TMMR) is the first radical hysterectomy procedure based on defined anatomical landmarks with all surgical steps. The new abdominal operation combines maximum resection of the oncologically relevant mesometrium with minimal tissue traumatization and sparing of the pelvic autonomic nervous system. The extended pelvic and low periaortic lymph node dissection which is part of the procedure includes the removal of the lymphatic tissue localized laterally and dorsally of the main vessels. A prospective multidimensional trial is currently under way to evaluate the potential of the total mesometrial resection to improve the therapeutic index in the surgical treatment of carcinoma of the uterine cervix, especially for high risk tumors.

Schlüsselwörter

Zervixkarzinom - radikale Hysterektomie - autonome Beckennerven - Narbenrezidive - operative Radikalität - Therapeutischer Index

Key words

Cancer of the uterine cervix - radical hysterectomy - pelvic autonomic nervous system - scar recurrences - surgical radicality - therapeutic index

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