33. Radical Hysterectomy in Cervical Cancer

Radical hysterectomy belongs to classical procedures in gynecological oncology with a history longer than a hundred years. The surgical technique and the role of radical hysterectomy in the management of cervical cancer have been developing dramatically and are still in progress. A commonly accepted indication is the treatment of cervical cancer stage IB1, in which radical hysterectomy achieves excellent oncological outcomes. Ongoing randomized trials are validating the possibility of abandoning parametria resection and replacing radical with simple hysterectomy in selected subgroups of patients with small tumors of IB1 stage. Surgical treatment can achieve satisfactory outcomes also in the management of locally advanced tumors of stages IB2, IIA and selected IIB on the condition that adequate radicality of hysterectomy and lymphadenectomy is performed.

Acceptance of harmonized terminology and a unified classification system is a challenging task for the specialty to enable comprehensive collaboration and further research. The ABCD classification system represents a modern and simple solution which recognizes four types of radical hysterectomy (B, C1, C2, D), including nerve sparing modification. A critical parameter for the classification is the resection extent of all three parts of parametria.

The extent of parametrectomy, particularly in vertical dimension, is the crucial factor for early and late morbidity. The most significant symptom in the early postoperative period is a failure of spontaneous voiding, while bladder dysfunctions, including urinary incontinence and impairment of bladder sensation, belong to common late postoperative complications. Quality of life can be also compromised due to less frequent symptoms such as anorectal dysfunctions, mainly constipation and flatulence incontinence as well as sexual dysfunctions.