Having gone through a complex history and evolution, Radical Hysterectomy has become the main treatment of patients with cervical cancer and part of the daily practice of many gynecological oncologists.
Removal of parametriums determines the radicality of operations for cervical cancer. Parametrium is a connective tissue that contains lymph nodes and vessels and forms the ligamentous apparatus of the uterus, fixing it to the walls of the pelvis - anterior parametrium, lateral parametrium and posterior parametrium.
Hysterectomy is usually performed for cancers of the uterus, cervix, or ovary. Hysterectomy can also be performed for other conditions, such as uterine fibroids, uterine prolapse and endometriosis, if improvement or recovery cannot be achieved with other treatment methods.
There are three types of uterine removal:
Supravaginal uterine amputation or subtotal hysterectomy (the cervix is preserved),
Extirpation of the uterus or total hysterectomy (removal of the body of the uterus together with its cervix),
Radical hysterectomy (with removal of the fallopian tubes and ovaries),
All of these options refer to radical operations, that is, to surgical intervention, which leads to the complete cure of patient.
Types of Radical Hysterectomy
In 1974, Piver-Rutledge developed a classification of radical hysterectomy, which was based on the degree of radicality of removal of parametrium. They believed that many surgeons performed different amounts of radical hysterectomy and, when reporting their treatment results, the term “radical hysterectomy” did not always fully reflect the different volumes of operations performed. Based on this, a classification was developed that distinguishes 5 types of radical operations on the uterus:
Type I - simple extrafascial hysterectomy
Type II - hysterectomy with removal of the medial half of the cardinal and sacro-uterine ligaments (that is, the lateral and posterior parameteriums), the upper third of the vagina and pelvic lymph nodes
Type III - hysterectomy with complete removal of the vesicouterine, cardinal, sacro-uterine ligaments, the upper third of the vagina and pelvic lymph nodes
Type IV - hysterectomy with complete removal of all peri-ureteric tissue, superior cystic artery, vesicouterine, cardinal and sacro-uterine ligaments, ¾ vagina and pelvic lymph nodes (used for tumors located centrally and anterior to the uterus)
Type V - partial pelvic exenteration - the volume of type IV surgery + removal of the distal parts of the ureters and the bladder (when the tumor grows into the bladder and cannot be preserved)
Damage to the bowel, bladder, or ureter
Urinary tract infection
Postoperative thrombosis and atelectasis
Early menopause and loss of ovarian function
Duration of Procedure
At the beginning of the 20th century, the issue of treating patients with cervical cancer was solved quite simply - they operated on those patients who could be operated on. Among doctors oncogynecologists, a rule has even appeared prescribing that any cervical cancer should be operated on as radically as possible. However, starting from the 1920s, radiation therapy began to develop gradually, and the first successes in the treatment of patients with cervical cancer appeared. Currently, indications for surgical and radiation treatment of cervical cancer have been determined, although on certain positions the controversy about the indications and contraindications for these types of treatment is still ongoing. In addition, in a significant proportion of patients, radiation therapy complements surgical treatment.
Stage IА1 in the presence of tumor emboli in the blood and lymphatic vessels according to the results of histological examination of the preparation after conization of the cervix (type II radical hysterectomy is performed)
IA1 (type II radical hysterectomy is performed)
IB1 and IIA1 stages - tumor less than 4 cm (type III radical hysterectomy is performed)
IB2 and IIA2 stages - tumor more than 4 cm (it is possible to perform type III radical hysterectomy)
Stage IIB (it is possible to perform the III type of radical hysterectomy in the absence of factors of unfavorable prognosis - metastases in the lymph nodes, lesions of the parametrium, tumor emboli in the lymphatic and blood vessels)
Stage IIIB with primary incurability after chemoradiation treatment
Providing anamnestic data. Detailed information about allergies and any co-morbidities, especially diabetes, hypertension, heart disease or asthma is required. Before surgery, it is important for doctor to know what medications patients are taking. If they are taking medications: aspirin; warfarin; insulin; antihyperglycemic drugs or their analogues, it is necessary to inform doctor.
General blood and urine tests
Blood group and Rh affiliation
Antibodies to HIV, hepatitis B and C
Swab or culture for flora and antibiotic
Papanicolaou test, histological examination of the endometrium
In addition to the above tests, ultrasound, biopsy, computed tomography, MRI, cystoscopy, tumor markers, etc. can be prescribed
Hysterectomy can be performed under spinal or general anesthesia. Patient can stay awake during spinal anesthesia unless sedation is given. With this type of anesthesia, only a certain part of the body becomes “numb” and does not feel pain. During general anesthesia, the patient is unconscious with the help of analgesics and sedatives and also does not feel pain.
The duration of the recovery period after the operation to remove the uterus depends on the method in which it was performed. But in any case, this is a serious intervention, after which the body will take time to recover.
What symptoms appear after hysterectomy? Patients complain about the following:
feeling nauseous if the operation was performed under general anesthesia;
disruption of the gastrointestinal tract;
Painful sensations disturb women inside the abdomen. Pain may worsen when urinating. This is due to damage to the lining of the urethra during surgery. To reduce pain, patient must be prescribed strong analgesics. This is also necessary to prevent the inflammatory process. With each passing day, the wound will heal, the tissue will regenerate, and the pain will subside. But uncomfortable sensations can remain for a long time.
This is due to the fact that nerve endings could be damaged during the operation. And although these unpleasant sensations may bother women for several more months, they will also pass.
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