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)