Radical hysterectomy and its importance in the concept of cervical cancer treatment

Abstract

The role and place of a radical hysterectomy in the concept of cervical cancer treatment, despite over one hundred years
of its traditional use, still excites controversy.
To fully understand the value of the surgical treatment, it is worth analysing and understanding the evolutionary path of
the radical hysterectomy and the changes that have occurred in this method over the years. This knowledge will allow for
a better understanding as to why the choice of therapy between surgery and radiochemotherapy in the early and locally
advanced stages of cervical cancer still raise doubts.
Both the introduced changes in the scope of surgery and the use of multi-module treatment - surgery with subsequent
radiation therapy did not significantly improve the results of cancer treatment, but significantly increased the prevalence
of side effects and therapy complications.
As cervical cancer most often affects relatively young women, the number of potential years of life after treatment is high.
Over 30% of women in Poland with cervical cancer are in the 45–49 years-old age group. From the perspective of these
data, obtaining a high therapeutic index, which is defined as the ratio of the number of healed patients to complications
and side effects of treatment significantly reducing the quality of life, is very important in the therapy process.
Regardless of the classical radical surgery, which has evolved over many years, a new concept of radical hysterectomy based
on tissue morphogenesis, called total mesometrial resection (TMMR) with therapeutic Lymph Node Dissection (tLND) with
no adjuvant radiotherapy, has recently been proposed.
Based on the ontogenetic research and the study of cancerous tumour development, the concept of TMMR was first introduced
by M. Höckel in 2001. In the research conducted by the author, encouraging results of the treatment of stages IB1,
IB2, IIA1 and IIA2, and selected cases of stage IIB [according to 2009 International Federation of Gynecology and Obstetrics
(FIGO)] cervical cancer were obtained.