Laterally extended parametrectomy in cases with cervical carcinoma

INTRODUCTION: Clinical staging of cervical carcinoma is not always an easy task, especially in cases with parametrial involvement, stage IIB. Therapeutic approach may differ in such patients- conservative (radio-, chemoradiation) therapy versus operative treatment. Research shows that the limits of the typical class III-IV radical hysterectomy may prove to be inadequate in relation to the dissection of the lateral parametria. A new surgical technique called laterally extended parametrectomy was published in 1993 and provides the means of total removal of the connective and lymphatic tissue up to the level of the true pelvic sidewall. MATERIAL AND METHODS: A retro- and prospective study was performed during the period between Jan 2008 and Feb 2011. A total of 17 radical hysterectomies with unilateral LEP were enrolled. Median age of patients was 51 years. Mean duration of surgery is 3 hours 57 min. Laterally extended parametrectomy was initiated in cases with clinically predetermined stage IB to II/IA cervical cancer. 3 patients were diagnosed with adenosquamous type of carcinoma, while the other 14 were with squamous cell cervical cancer. RESULTS: Positive iliac lymph nodes were found bilaterally in 7 patients, unilaterally also in 7 patients, while 3 cases proved to be negative. Paraaortic lymph node dissection was performed in 6 surgeries, with positive histology in 4 cases. Parametrial infiltration was found in 6 patients, 3 of them bilateral. 8 of the patients had unilateral hydroureter. CONCLUSION: Laterally extended parametrectomy is a surgical technique which provides the means for full removal of the lymphatics and connective tissue up to the pelvic sidewall, during radical hysterectomy in patients with cervical cancer, stage IB and IIA, with positive iliac lymph nodes, as well as in stage IIB cases. It offers an efficient alternative for surgical treatment of locally advanced cervical cancer, opposed to the other therapeutic approaches.