New Surgical Technique Shows Promising Results for Women with Cervical Cancer
A new surgical technique could allow surgeons to perform a radical hysterectomy in women with early-stage cervical cancer – with fewer complications, reduced morbidity, and a lower risk of local tumor recurrence than current surgical methods, according to an article published in The Lancet Oncology. The technique, called total mesometrial resection, is a modified version of the traditional radical hysterectomy and involves more accurate, anatomically based resection of the cancer to prevent damage to the pelvic autonomic nervous system and to minimize surgical trauma.
For over 100 years, radical hysterectomy has been the standard surgical treatment for early-stage cervical cancer. However, the procedure has a relatively high rate of tumor recurrence and many women experience postoperative bladder and bowel dysfunction because of damage to the autonomic nerve system. In addition, postoperative radiotherapy – given as part of standard treatment – can have considerable unpleasant side effects.
Current surgical practice is to remove the pelvic tissue adjacent to the tumor along with the cervix because of the risk of it harboring cervical cancer. However, it has been suggested that local tumor spread may be restricted to the Müllerian compartment (fallopian tubes, uterus, and proximal, middle vagina and their embryologically defined mesotissues) for relatively long phases in its natural course, and that the removal of the complete Müllerian compartment in early-stage disease could improve local tumor control while reducing surgery-associated morbidity.
To improve on traditional radical hysterectomy and to show that the early stages of tumor growth are confined to the Müllerian compartment, Michael Höckel and colleagues assessed the effectiveness of total mesometrial resection without radiotherapy in 212 women with early-stage cervical cancer between 1999 and 2008 at the University of Leipzig in Germany. In this study, they report the histopathological tumor stages, resection margins, local recurrence, surgical morbidity, and five-year outcomes of these women.
Overall, findings showed recurrence-free survival of 94 percent and five-year survival of 96 percent, with low treatment-related disease. At a median follow-up of 41 months, only 10 women had a recurrence of their cancer.
The authors state, “Based on historical controls, total mesometrial resection without adjuvant radiation has the potential to improve survival by 15 to 20 percent.” They conclude by calling for further evaluation of the technique with multi-institutional controlled trials.
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This article was published in Coping® with Cancer magazine, July/August 2009.