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Chikazawa K, Imai K, Kuwata T, Konno R. Improved bladder function in radical hysterectomy without worsening oncologic outcome: resection of the posterior layer of the vesicouterine ligament with the procedure limited to the vesical veins. J Gynecol Oncol 2024; 35:e28. [PMID: 38156721 PMCID: PMC11107269 DOI: 10.3802/jgo.2024.35.e28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 10/02/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE The classic Okabayashi nerve-sparing radical hysterectomy involves complete resection of the posterior leaf of the vesicouterine ligament, whereas in the simplified nerve-sparing radical hysterectomy, only the vesical veins and some connective tissue of the posterior layer of the vesicouterine ligament are resected. This study aimed to compare bladder function and cervical carcinoma relapse-free survival between these two techniques. METHODS We conducted a retrospective, historical control study. All female patients aged >20 years who were diagnosed with cervical cancer stage IB1-IIB and underwent radical hysterectomy with pelvic lymphadenectomy between 2009 and 2022 were enrolled. Patients who had a history of other cancers and those who were treated with non-surgical approaches or non-radical hysterectomy were excluded. The primary outcome was relapse-free survival during the follow-up period. RESULTS A total of 114 patients who underwent curative-intent radical hysterectomy were included in this study. The median follow-up duration was 60 months. No significant difference was observed in relapse-free survival between the two surgical procedures. The simplified nerve-sparing radical hysterectomy was superior in terms of both motor and sensory bladder function outcomes. CONCLUSION Resection of the posterior layer of the vesicouterine ligament, with the procedure limited to the vesical veins, is an effective and safe method for radical hysterectomy. It may be more useful for preserving the bladder function, without leading to unfavorable oncologic outcomes.
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Affiliation(s)
- Kenro Chikazawa
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan.
| | - Ken Imai
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Tomoyuki Kuwata
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan
| | - Ryo Konno
- Department of Obstetrics and Gynecology, Jichi Medical University, Saitama Medical Center, Saitama, Japan
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Robin F, Roux L, Zaheer MA, Sulpice L, Dion L, Lavoue V, Landreau J, Morandi X, Nyangoh Timoh K. A reappraisal of the deep uterine vein: a multimodal exploration with implications for pelvic surgery. Surg Radiol Anat 2024; 46:381-390. [PMID: 38493417 DOI: 10.1007/s00276-024-03316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/25/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Pelvic gynecological surgeries, whether for malignant or benign conditions, frequently result in functional complications due to injuries to the autonomic nervous system. Recognizing the deep uterine vein (DUV) as an essential anatomical reference can aid in preserving these structures. Despite its significance, the DUV is infrequently studied and lacks comprehensive documentation in Terminologia Anatomica. This research endeavors to elucidate a detailed characterization of the DUV. METHODS We undertook a systematic literature review aligning with the "PRISMA" guidelines, sourcing from PUBMED and EMBASE. Our comprehensive anatomical examination encompassed cadaveric dissections and radio-anatomical evaluations utilizing the Anatomage® Table. RESULTS The literary exploration revealed a consensus on the DUV's description based on both anatomical and surgical observations. It arises from the merger of cervical, vesical, and vaginal veins, coursing through the paracervix in a descending and rearward direction before culminating in the internal iliac vein. The hands-on anatomical study further delineated the DUV's associations throughout its course, highlighting its role in bifurcating the uterus's lateral aspect into two distinct zones: a superior vascular zone housing the uterine artery and ureter and an inferior nervous segment below the DUV representing the autonomic nerve pathway. CONCLUSION A profound understanding of the subperitoneal space anatomy is paramount for pelvic surgeons to mitigate postoperative complications. The DUV's intricate neurovascular interplays underscore its significance as an indispensable surgical guide for safeguarding nerves and the ureter.
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Affiliation(s)
- Fabien Robin
- Department of Digestive Surgery and Liver Transplantation, Rennes University Hospital, Rennes, France
- INSERM OSS U1242, University Hospital, Rennes 1 University, Rennes, France
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Léa Roux
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Myra A Zaheer
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Laurent Sulpice
- Department of Digestive Surgery and Liver Transplantation, Rennes University Hospital, Rennes, France
- INSERM OSS U1242, University Hospital, Rennes 1 University, Rennes, France
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Ludivine Dion
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
| | - Vincent Lavoue
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Julien Landreau
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Xavier Morandi
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France
| | - Krystel Nyangoh Timoh
- Anatomy Laboratory, Faculty of Medicine, University of Rennes 1, Rennes, France.
- Department of Gynecology, Rennes University Hospital, 16, Boulevard de Bulgarie, 35000, Rennes, France.
- Rennes University, INSERM, LTSI-UMR 1099, F35000, Rennes, France.
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Kostov S, Sorokin P, Rezende B, Yalçın H, Selçuk I. Radical Hysterectomy or Total Mesometrial Resection-Two Anatomical Concepts for Surgical Treatment of Cancer of the Uterine Cervix. Cancers (Basel) 2023; 15:5295. [PMID: 37958469 PMCID: PMC10650459 DOI: 10.3390/cancers15215295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
A radical hysterectomy is the standard method of surgical treatment for patients with early-stage cancer of the uterine cervix. It was first introduced more than 100 years ago. Since then, various and many different radical procedures, which diverge in terms of radicality, have been described. Inconsistencies are clearly seen in practical anatomy, which were defined as surgically created artifacts. Moreover, the disparity of the procedure is most notable regarding the terminology of pelvic connective tissues and spaces. Despite these controversies, the procedure is widely performed and implemented in the majority of guidelines for the surgical treatment of cancer of the uterine cervix. However, a different and unique concept of surgical treatment of cervical cancer has been reported. It is based on ontogenetic anatomy and maps any tissue in the mature organism according to its embryologic development. The clinical implementation of this theory in the context of early cervical cancer is total mesometrial resection. The present article aims to describe and compare the anatomical and surgical basics of a radical hysterectomy (type C1/C2) and total mesometrial resection. Discrepancies regarding the terminology, resection lines, and surgical planes of both procedures are highlighted in detail. The surgical anatomy of the pelvic autonomic nerves and its surgical dissection is also delineated. This is the first article that compares the discrepancy of classic anatomy and ontogenic anatomy regarding surgical treatment of cancer of the uterine cervix. Clinical data, oncological outcome, and neoadjuvant and adjuvant treatment regarding both procedures are not the topic of the present article.
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Affiliation(s)
- Stoyan Kostov
- Department of Gynecology, Hospital “Saint Anna”, Medical University—“Prof. Dr. Paraskev Stoyanov”, 9002 Varna, Bulgaria
- Research Institute, Medical University Pleven, 5800 Pleven, Bulgaria
| | - Pavel Sorokin
- Department of Gynecologic Oncology, Moscow City Oncology Hospital No. 62, Istra, 27, Str. 1-30, Moscow Region 143515, Russia;
| | - Bruno Rezende
- Department of Gynecologic oncology, Londrina Cancer Hospital, Londrina 86015-520, Brazil;
| | - Hakan Yalçın
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Maternity Hospital, 06800 Ankara, Turkey; (H.Y.); (I.S.)
| | - Ilker Selçuk
- Department of Gynecologic Oncology, Ankara Bilkent City Hospital, Maternity Hospital, 06800 Ankara, Turkey; (H.Y.); (I.S.)
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