A New Anatomic and Staging-Oriented Classification of Radical Hysterectomy

Simple Summary The main deficits of the available classifications of radical hysterectomy are the facts that they are based only on the lateral extension of resection, do not depend on the precise anatomy of parametrium and paracolpium and do not correlate with the tumour stage, size or infiltration in the vagina. This new suggested classification depends on the 3-dimentional concept of parametrium and paracolpium and the comprehensive description of the anatomy of parametrium, paracolpium and the pelvic autonomic nerve system. Each type in this classification tailored to the tumour stage according to FIGO- classification from 2018, taking into account the tumour size, localization and infiltration in the vaginal vault, which may make it the most suitable tool for planning and tailoring the surgery of radical hysterectomy. The current understanding of radical hysterectomy more is centered on the uterus and little is being discussed about the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. This is because that the current classifications of radical hysterectomy are based only on the lateral extent of resection. This way is easier to be understood but does not reflect the anatomical and surgical conception of radical hysterectomy and the three-dimensional ways of tumour spreading, neither meet the need of adjusting the radicality according to the different stages of FIGO classification, which depends-at least in the early stages-on the tumour volume and the infiltration in the vagina (but not on the directly spread in the parametrium). The new classification presented in this paper does not base anymore on the lateral extent of resection only but too on the depth of resection in the small pelvic and the extent of the resected vaginal vault without or with its three-dimensional paracolpium. This classification takes into account the tumour size, stage, localization and infiltration in the vaginal vault and may offer the optimal tool to adjust and tailor the surgery according to these important variables.

Automated summary

The current classifications of radical hysterectomy are limited by focusing only on lateral resection extension, while the new proposed three-dimensional classification takes into account tumor size, stage, localization, and infiltration in the vaginal vault for more precise surgical planning and customization.