Zusammenfassung
Fragestellung
Fragestellung: Kann der therapeutische Index bei der operativen Behandlung des Zervixkarzinoms verbessert werden?
Methodik
Methodik: Liposuction-assistierte Untersuchungen der topographischen Neuroanatomie im Becken weiblicher Körperspender bildeten die Grundlage für die Entwicklung der nervenschonenden radikalen Hysterektomie [11].
Ergebnisse
Ergebnisse: Die nervenschonende radikale Hysterektomietechnik unterscheidet sich von der traditionellen Wertheim-Meigs-Operation durch: 1. Resektion von zusätzlichem Risikogewebe, insbesondere im inferioren posterioren Parametrium sowie lateral und dorsal der großen Beckengefäße; 2. Reduktion des Gewebetraumas durch Präparation in durch die Embryonalentwicklung vorgegebenen Ebenen; 3. Darstellen und Schonen wesentlicher Anteile des autonomen Beckennervensystems.
Schlussfolgerung
Schlussfolgerung: Die Umsetzung neuer anatomischer und tumorbiologischer Erkenntnisse in die Technik der nervenschonenden radikalen Hysterektomie eröffnet eine Möglichkeit, die operative Behandlung des Zervixkarzinoms zu verbessern.
Abstract
Objective
Objective: To improve the therapeutic index of the surgical treatment of cervical cancer.
Methods
Methods: The technique of nerve-sparing radical hysterectomy was developed based on liposuction-assisted neuroanatomical studies of the female pelvis.
Results
Results: Compared with conventional radical hysterectomy, the nerve-sparing procedure permitted the resection of more parametrial tissue, particularly in the inferior and posterior parametrium as well as lateral to and behind the major vessels. Tissue trauma was reduced by dissection along embryologically preformed planes. Major portions of the autonomic pelvic nerve supply were dissected out and preserved.
Conclusions
Conclusions: The application of new anatomical and tumor biological findings in nerve-sparing radical hysterectomy may improve the surgical treatment of cervical cancer.
Literatur
-
1
Benedetti-Panici P, Maneschi F, Scambia G, Greggi S, Cutillo G, D'Andrea G, Rabitti C, Coronetta F, Capelli A, Mancuso S.
Lymphatic spread of cervical cancer: An anatomical and pathological study based on 225 radical hysterectomies with systematic pelvic and aortic lymphadenectomy.
Gynecol Oncol.
1996;
62
19-24
-
2
Bergmark K, Avall-Lundqvist E, Dickman P W, Henningsohn L, Steineck G.
Vaginal changes and sexuality in women with a history of cervical cancer.
N Engl J Med.
1999;
340
1383-1389
-
3
Burghardt E, Baltzer J, Tulusan A H, Haas J.
Results of surgical treatment of 1028 cervical cancers studied with volumetry.
Cancer.
1992;
70
648-655
-
4
Burghardt E.
Radicality in gynecologic cancer surgery: A historical perspective.
Gynecol Oncol.
1998;
70
172-175
-
5
Dargent D, Brun J L, Roy M, Methevet P, Remy I.
La trachélectomie élargie (TE). Une alternative à l'hystérectomie radicale dans le traitement des cancers infiltrants développés sur la face externe du col utérin.
JobGyn.
1994;
2
285-292
-
6
Dargent D, Mathevet P.
Schauta's vaginal hysterectomy combined with laparoscopic lymhadenectomy.
Baillieres Clin Obstet Gynaecol.
1995;
9
105-109
-
7
Fotiou S, Tserkezoglou A, Hatzieleftheriou G, Apostolikas N.
Class III vs class II radical hysterectomy in stage IB cervical carcinoma: a comparison of morbidity and survival.
Int J Gynecol Cancer.
1997;
7
117-121
-
8
Friedberg V.
Operative therapy for stage IIB cervical cancer.
Baillieres Clin Obstet Gynaecol.
1988;
2
973-980
-
9
Girardi F, Pickel H, Winter R.
Pelvic and parametrial lymph nodes in the quality control of the surgical treatment of cervical cancer.
Gynecol Oncol.
1993;
50
330-333
-
10
Höckel M, Schlenger K, Hamm H, Knapstein P G, Hohenfellner R, Rösler H P.
Five-year experience with combined operative and radiotherapeutic treatment of recurrent gynecologic tumors infiltrating the pelvic wall.
Cancer.
1996;
77
1918-1933
-
11
Höckel M, Konerding M A, Heußel C P.
Liposuction-assisted nerve-sparing extended radical hysterectomy: Oncologic rationale, surgical anatomy, and feasibility study.
Am J Obstet Gynecol.
1998;
178
971-976
-
12
Höckel M.
Laterally extended endopelvic resection: Surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies.
Am J Obstet Gynecol.
1999;
180
306-312
-
13
Höckel M.
Pelvic recurrences of cervical cancer. Relapse pattern, prognostic factors, and the role of extended radical treatment.
J Pelvic Surg.
1999;
5
255-266
-
14
Kadar N, Salbia N, Nelson J H.
The frequency, causes and prevention of severe urinary dysfunction after radical hysterectomy.
Br J Obstet Gynaecol.
1983;
90
858-863
-
15
Lahousen M, Haas J, Pickel H, Hackl A, Kurz C, Ogris H, Stummvoll W, Winter R.
Chemotherapy versus radiotherapy versus observation for high-risk cervical carcinoma after radical hysterectomy: A randomized, prospective, multicenter trial.
Gynecol Oncol.
1999;
73
196-201
-
16
Lin H H, Cheng W F, Chan K WA, Chang D Y, Chen C K, Huang S C.
Risk factors for recurrence in patients with stage IB, IIA and IIB cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation.
Obstet Gynecol.
1996;
88
274-279
-
17
Magrina J F, Goodrich M A, Lidner T K, Weaver A L, Cornella J L, Podratz K C.
Modified radical hysterectomy in the treatment of early squamous cervical cancer.
Gynecol Oncol.
1999;
72
183-186
-
18
Manzl J, Marberger F, Hetzel H, Klammer J, Geir W, Dapunt O.
Funktionelle Störungen des unteren Harntraktes nach Radikaloperation des Kollumkarzinoms.
Geburtsh u Frauenheilk.
1981;
41
145-150
-
19
Meigs J V.
Carcinoma of the cervix: the Wertheim operation.
Surg Gynecol Obstet.
1944;
78
195-198
-
20
Nezhat C R, Burrell M O, Nezhat F R, Benigno B B, Welander C E.
Laparoscopic radical hysterectomy with paraaortic and pelvic node dissection.
Am J Obstet Gynecol.
1992;
166
864-865
-
21
Okabayashi H.
Radical abdominal hysterectomy for cancer of the cervix uteri.
Surg Gynecol Obstet.
1921;
33
335-341
-
22 Petri E. Bladder dysfunction after intraabdominal or vaginal surgery. Ostergard DR, Bent AE Urogynecology and Urodynamics. Baltimore; Williams & Williams 1996
-
23
Piver M S, Rutledge F, Smith J P.
Five classes of extended hysterectomy for women with cervical cancer.
Obstet Gynecol.
1974;
44
265-272
-
24
Possover M, Krause N, Kuhne-Heid R, Schneider A.
Laparoscopic assistance for extended radicality of radical vaginal hysterectomy: description of a technique.
Gynecol Oncol.
1998;
70
94-99
-
25
Sardi J, Sananes C, Giaroli A, Bayo J, Gomes Rueda N, Vighi S.
Results of a prospective randomized trial with neoadjuvant chemotherapy in stage IB, bulky, squamous carcinoma of the cervix.
Gynecol Oncol.
1993;
49
156-165
-
26
Sardi J E, Sananes C E, Giaroli A A, Bermúdez A, Ferreira M H, Soderini A H, Snaidas L, Guardado N, Anchezar P, Contreras Ortiz O, DiPaola G R.
Neoadjuvant chemotherapy in cervical carcinoma stage IIB. a randomized controlled trial.
Int J Gynecol Cancer.
1998;
8
441-450
-
27
Sartori E, Fallo L, LaFace B, Bianchi U A, Pecorelli S.
Extended radical hysterectomy in early-stage carcinoma of the uterine cervix: tailoring the radicality.
Int J Gynecol Cancer.
1995;
5
143-147
-
28
Schneider A, Possover M, Kamprath S, Endisch U, Krause N, Noschel H.
Laparoscopy-assisted radical vaginal hysterectomy modified according to Schauta-Stoeckel.
Obstet Gynecol.
1996;
88
1057-1060
-
29
Sedlis A, Bundy B N, Rotman M Z, Lentz S S, Muderspach L I, Zaino R J.
A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A gynecologic oncology group study.
Gynecol Oncol.
1999;
73
177-183
-
30
Sekido N, Kaeai K, Akaza H.
Lower urinary tract dysfunction as persistent complication of radical hysterectomy.
Int J Urol.
1997;
4
259-264
-
31
Thiel W.
Die Konservierung ganzer Leichen in natürlichen Farben.
Ann Anat.
1992;
174
185-195
-
32
Wertheim E.
The extended abdominal operation for carcinoma uteri (based on 500 operative cases).
Am J Obstet Dis Women Child.
1912;
66
169-232
Univ.-Prof. Dr. Dr. Michael Höckel
Universitätsfrauenklinik
Philipp-Rosenthal-Strasse 55
04103 Leipzig
