Compartment-based radical resection: total mesometrial resection by Michael Hockel. A novel approach to the radical treatment of early-stage cervical cancer patients


Aim: During the last 12 years a new theory regarding the radical treatment of cervical cancer has been embraced by onco-gynecologysts aiming at improving surgical outcomes, decreasing the complications rates and the need for adjuvant radiotherapy.
Rationale: This new theory named ontogenetic compartment theory has been proposed by Michael Hȍckeland and is based on the fact that tumor growth is restricted to certain compartments which have their origin in the same primordium during the ontogenesis. Hȍckel’s principles of radicality specifically refer to the radical resection of tumor-bearing compartment with metricallyintact borders. A completere section of this compartment has the advantage of avoiding removal of adjacent tissues with other embryonic origin, whereas an incomplete removal of the compartment is associated with a high risk of tumor recurrence and poor local control. Total mesometrial resection (TMMR) is the surgical technique developed in the school of Radical Pelvic Surgery from Leipzig, Germany basing on the same principle of ontogenetic compartment-based resection. A complete radical compartment resection provides a good local control, a low rate of postoperative complications and the avoidance of adjuvant radiotherapy.

Conclusion: Analyzing the scientific evidence about TMMR in terms of morbidity, mortality, survival rates, and local control, TMMR may represent the future in the treatment of early-stage cervical cancer patients. Abbreviations: TMMR=total mesometrial resection; FIGO= International Federation of Obstetrics and Gynecology; LN= lymph node; VS= Piver-Rutledge-Smith; OS=overall survival

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