Totale mesometriale Resektion: Nervenschonende erweitert radikale abdominale Hysterektomie

 

 Buy Article Permissions and Reprints

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.

Literatur

• 1 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
  CrossrefPubMedGoogle Scholar
• 2 Burghardt E, Baltzer J, Tulusan A H, Haas J. Results of surgical treatment of 1 028 cervical cancers studied with volumetry.  Cancer. 1992;  70 648-655
  PubMedGoogle Scholar
• 3 Friedberg V. Operative therapy for stage II B cervical cancer.  Baillieres Clin Obstet Gynaecol. 1988;  2 973-980
  PubMedGoogle Scholar
• 4 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
  CrossrefPubMedGoogle Scholar
• 5 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
  CrossrefPubMedGoogle Scholar
• 6 Höckel M. Laterally extended endopelvic resection: Surgical treatment of infrailiac pelvic wall recurrences of gynecologic malignancies.  Am J Obstet Gynecol. 1999;  180 306-312
  PubMedGoogle Scholar
• 7 Höckel M. Pelvic recurrences of cervical cancer. Relapse pattern, prognostic factors, and the role of extended radical treatment.  J Pelvic Surg. 1999;  255-266
  PubMedGoogle Scholar
• 8 Höckel M, Wolff W, Schmidt W, Spanel-Borowski K. Nerve-sparing radical hysterectomy: I. Anatomical principles and surgical technique.  Geburtshilfe Frauenheilkd. 2000;  60 314-319
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Höckel M, Naumann G, Alexander H, Horn L C, Fischer U, Schmidt F, Heußel C P. Nerve-sparing radical hysterectomy: II. Results after three years.  Geburtshilfe Frauenheilkd. 2000;  60 320-325
  PubMedGoogle Scholar
• 10 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
  PubMedGoogle Scholar
• 11 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
  CrossrefPubMedGoogle Scholar
• 12 Lin H H, Cheng W F, Chan K W A, Chang D Y, Chen C K, Huang S C. Risk factors for recurrence in patients with stage I B, II A and II B cervical carcinoma after radical hysterectomy and postoperative pelvic irradiation.  Obstet Gynecol. 1996;  88 247-279
  PubMedGoogle Scholar
• 13 Meigs J V. Carcinoma of the cervix: the Wertheim operation.  Surg Gynecol Obstet. 1944;  78 195-198
  PubMedGoogle Scholar
• 14 Okabayashi H. Radical abdominal hysterectomy for cancer of the cervix uteri.  Surg Gynecol Obstet. 1921;  33 335-431
  PubMedGoogle Scholar
• 15 Piver M S, Rutledge F, Smith J P. Five classes of extended hysterectomy for women with cervical cancer.  Obstet Gynecol. 1974;  44 265-272
  Google Scholar
• 16 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 I B carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: A gynecologic oncology group study.  Gynecol Oncol. 1999;  73 177-183
  CrossrefPubMedGoogle Scholar
• 17 Sekido N, Kaeai K, Akaza H. Lower urinary tract dysfunction as persistent complication of radical hysterectomy.  Int J Urol. 1997;  4 259-264
  PubMedGoogle Scholar
• 18 Wertheim E. The extended abdominal operation for carcinoma uteri (based on 500 operative cases).  Am J Obstet Dis Women Child. 1912;  66 169-232
  PubMedGoogle Scholar

Univ.-Prof. Dr. Dr. Michael Höckel

Universitätsfrauenklinik

Philipp-Rosenthal-Str. 55

D-04103 Leipzig

Phone: Tel.: 03 41/9¿72 34 00

Email: E-mail: hoeckelm@medizin.uni-leipzig.de