Embryologically based resection of cervical cancers: a new concept of surgical radicality.
Objectives With the objective of improving outcomes in oncological surgery, a new concept of surgical anatomy deduced from embryonic development, called ontogenetic anatomy and compartment theory of local tumor spread, is proposed by Michael Höckel from Germany. Hypothesis Compartment resection enables the preservation of functionally important tissues of different embryonic origin despite its close proximity to the tumor and incomplete resection of the compartment results in increase in local recurrences. This approach should maximize local tumor control and minimize treatment-related morbidity. Total Mesometrial Resection (TMMR) This new surgical technique has been developed and standardized over past 12 years for cervical cancer with a high local control rate without need for adjuvant radiotherapy. Conclusion This Embryological based surgery holds a great promise for management of cervical cancer. However this novel surgery needs confirmation in multi institutional settings to translate research into practice for an excellent therapeutic index.
Department of Obstetrics and Gynecology, Kasturba Medical College, Manipal University, Manipal, 576 104 Karnataka India.
Attibele Palaksha
AP
Manjunath
Shivarudraiah
S
Girija
Cervical cancer; Compartment theory; Ontogenetic anatomy; Total mesometrial resection