Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Radical hysterectomy

INTRODUCTION

Radical hysterectomy refers to the excision of the uterus en bloc with the parametrium (ie, round, broad, cardinal, and uterosacral ligaments) and the upper one-third to one-half of the vagina. The surgeon usually also performs a bilateral pelvic lymph node dissection. The procedure requires a thorough knowledge of pelvic anatomy, meticulous attention to sharp dissection, and careful technique to allow dissection of the ureters and mobilization of both bladder and rectum from the vagina. Particular care must be taken with the vasculature of the pelvic side walls and the venous plexuses at the lateral corners of the bladder to avoid excessive blood loss. Removal of the ovaries and fallopian tubes is not part of a radical hysterectomy; they may be preserved if clinically appropriate. (See "Elective oophorectomy or ovarian conservation at the time of hysterectomy", section on 'Introduction'.)

The major issues associated with radical hysterectomy will be reviewed here including indications, patient selection, operative technique, preoperative and postoperative care and complications. The outcomes after surgery and comparisons to other therapeutic modalities for specific tumors are discussed separately.

INDICATIONS

Radical hysterectomy is performed as a primary therapy for:

Stage IB or IIA cancer of the cervix (table 1)

Selected patients with stage II adenocarcinoma of the endometrium in whom radical surgery seems feasible

                              

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Jun 2014. | This topic last updated: Apr 28, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Landoni F, Maneo A, Colombo A, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997; 350:535.
  2. Kelso JW, Funnel JW. Radical Wertheim hysterectomy. Twenty years' experience. Am J Obstet Gynecol 1967; 99:106.
  3. Hoskins WJ, Ford JH Jr, Lutz MH, Averette HE. Radical hysterectomy and pelvic lymphadenectomy for the management of early invasive cancer of the cervix. Gynecol Oncol 1976; 4:278.
  4. Lee YN, Wang KL, Lin MH, et al. Radical hysterectomy with pelvic lymph node dissection for treatment of cervical cancer: a clinical review of 954 cases. Gynecol Oncol 1989; 32:135.
  5. Webb MJ, Symmonds RE. Wertheim hysterectomy: a reappraisal. Obstet Gynecol 1979; 54:140.
  6. Underwood PB Jr, Wilson WC, Kreutner A, et al. Radical hysterectomy: a critical review of twenty-two years' experience. Am J Obstet Gynecol 1979; 134:889.
  7. Rutledge S, Carey MS, Prichard H, et al. Conservative surgery for recurrent or persistent carcinoma of the cervix following irradiation: is exenteration always necessary? Gynecol Oncol 1994; 52:353.
  8. Benedet JL, Turko M, Boyes DA, et al. Radical hysterectomy in the treatment of cervical cancer. Am J Obstet Gynecol 1980; 137:254.
  9. Powell JL, Burrell MO, Franklin EW 3rd. Radical hysterectomy and pelvic lymphadenectomy. Gynecol Oncol 1981; 12:23.
  10. Shuster PA, Barter JF, Potkul RK, et al. Radical hysterectomy morbidity in relation to age. Obstet Gynecol 1991; 78:77.
  11. Trimbos JB, Franchi M, Zanaboni F, et al. 'State of the art' of radical hysterectomy; current practice in European oncology centres. Eur J Cancer 2004; 40:375.
  12. O'Leary JA, Symmonds RE. Radical pelvic operations in the geriatric patient. A 15-year review of 133 cases. Obstet Gynecol 1966; 28:745.
  13. Lawton FG, Hacker NF. Surgery for invasive gynecologic cancer in the elderly female population. Obstet Gynecol 1990; 76:287.
  14. Kinney WK, Egorshin EV, Podratz KC. Wertheim hysterectomy in the geriatric population. Gynecol Oncol 1988; 31:227.
  15. Fuchtner C, Manetta A, Walker JL, et al. Radical hysterectomy in the elderly patient: analysis of morbidity. Am J Obstet Gynecol 1992; 166:593.
  16. MASTERSON JG. RADICAL SURGERY IN EARLY CARCINOMA OF THE CERVIX. Am J Obstet Gynecol 1963; 87:601.
  17. Geisler JP, Geisler HE. Radical hysterectomy in patients 65 years of age and older. Gynecol Oncol 1994; 53:208.
  18. Soisson AP, Soper JT, Berchuck A, et al. Radical hysterectomy in obese women. Obstet Gynecol 1992; 80:940.
  19. Mann WJ Jr, Orr JW Jr, Shingleton HM, et al. Perioperative influences on infectious morbidity in radical hysterectomy. Gynecol Oncol 1981; 11:207.
  20. Tillmanns TD, Kamelle SA, Abudayyeh I, et al. Panniculectomy with simultaneous gynecologic oncology surgery. Gynecol Oncol 2001; 83:518.
  21. Hopkins MP, Shriner AM, Parker MG, Scott L. Panniculectomy at the time of gynecologic surgery in morbidly obese patients. Am J Obstet Gynecol 2000; 182:1502.
  22. Wright JD, Powell MA, Herzog TJ, et al. Panniculectomy: improving lymph node yield in morbidly obese patients with endometrial neoplasms. Gynecol Oncol 2004; 94:436.
  23. Geetha P, Nair MK. Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review. J Minim Access Surg 2012; 8:67.
  24. Delgado G, Bundy B, Zaino R, et al. Prospective surgical-pathological study of disease-free interval in patients with stage IB squamous cell carcinoma of the cervix: a Gynecologic Oncology Group study. Gynecol Oncol 1990; 38:352.
  25. Alvarez RD, Gelder MS, Gore H, et al. Radical hysterectomy in the treatment of patients with bulky early stage carcinoma of the cervix uteri. Surg Gynecol Obstet 1993; 176:539.
  26. Maas CP, ter Kuile MM, Laan E, et al. Objective assessment of sexual arousal in women with a history of hysterectomy. BJOG 2004; 111:456.
  27. http://www.cdc.gov/ncidod/dhqp/guidelines.html (Accessed May 6, 2008).
  28. Piver MS, Rutledge F, Smith JP. Five classes of extended hysterectomy for women with cervical cancer. Obstet Gynecol 1974; 44:265.
  29. Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol 2008; 9:297.
  30. Kolbenstvedt A, Kolstad P. The difficulties of complete pelvic lymph node dissection in radical hysterectomy for carcinoma of the cervix. Gynecol Oncol 1976; 4:244.
  31. Suzuki M, Ohwada M, Sato I. Pelvic lymphocysts following retroperitoneal lymphadenectomy: retroperitoneal partial "no-closure" for ovarian and endometrial cancers. J Surg Oncol 1998; 68:149.
  32. Morice P, Lassau N, Pautier P, et al. Retroperitoneal drainage after complete Para-aortic lymphadenectomy for gynecologic cancer: a randomized trial. Obstet Gynecol 2001; 97:243.
  33. Anderson B. Ovarian function after radical hysterectomy. Gynecol Oncol 1995; 56:1.
  34. Halmesmäki K, Hurskainen R, Tiitinen A, et al. A randomized controlled trial of hysterectomy or levonorgestrel-releasing intrauterine system in the treatment of menorrhagia-effect on FSH levels and menopausal symptoms. Hum Reprod 2004; 19:378.
  35. Crisp WE. The Schauta operation. Obstet Gynecol 1969; 33:453.
  36. Sonoda Y, Abu-Rustum NR. Schauta radical vaginal hysterectomy. Gynecol Oncol 2007; 104:20.
  37. Frumovitz M, Ramirez PT. Total laparoscopic radical hysterectomy: surgical technique and instrumentation. Gynecol Oncol 2007; 104:13.
  38. Li G, Yan X, Shang H, et al. A comparison of laparoscopic radical hysterectomy and pelvic lymphadenectomy and laparotomy in the treatment of Ib-IIa cervical cancer. Gynecol Oncol 2007; 105:176.
  39. Tillmanns, TD, Lowe, MP. Update on minimally invasive surgery in the management of gynecologic malignancies: focus on robotic laparoscopic systems. Community Oncology 2007; 4:505.
  40. Naik R, Jackson KS, Lopes A, et al. Laparoscopic assisted radical vaginal hysterectomy versus radical abdominal hysterectomy--a randomised phase II trial: perioperative outcomes and surgicopathological measurements. BJOG 2010; 117:746.
  41. Malur S, Possover M, Michels W, Schneider A. Laparoscopic-assisted vaginal versus abdominal surgery in patients with endometrial cancer--a prospective randomized trial. Gynecol Oncol 2001; 80:239.
  42. Hertel H, Köhler C, Michels W, et al. Laparoscopic-assisted radical vaginal hysterectomy (LARVH): prospective evaluation of 200 patients with cervical cancer. Gynecol Oncol 2003; 90:505.
  43. Steed H, Rosen B, Murphy J, et al. A comparison of laparascopic-assisted radical vaginal hysterectomy and radical abdominal hysterectomy in the treatment of cervical cancer. Gynecol Oncol 2004; 93:588.
  44. Morgan DJ, Hunter DC, McCracken G, et al. Is laparoscopically assisted radical vaginal hysterectomy for cervical carcinoma safe? A case control study with follow up. BJOG 2007; 114:537.
  45. Obermair A, Gebski V, Frumovitz M, et al. A phase III randomized clinical trial comparing laparoscopic or robotic radical hysterectomy with abdominal radical hysterectomy in patients with early stage cervical cancer. J Minim Invasive Gynecol 2008; 15:584.
  46. Ramirez PT, Schmeler KM, Wolf JK, et al. Robotic radical parametrectomy and pelvic lymphadenectomy in patients with invasive cervical cancer. Gynecol Oncol 2008; 111:18.
  47. Sert B, Abeler V. Robotic radical hysterectomy in early-stage cervical carcinoma patients, comparing results with total laparoscopic radical hysterectomy cases. The future is now? Int J Med Robot 2007; 3:224.
  48. Fanning J, Fenton B, Purohit M. Robotic radical hysterectomy. Am J Obstet Gynecol 2008; 198:649.e1.
  49. Magrina JF, Kho RM, Weaver AL, et al. Robotic radical hysterectomy: comparison with laparoscopy and laparotomy. Gynecol Oncol 2008; 109:86.
  50. Boggess JF, Gehrig PA, Cantrell L, et al. A case-control study of robot-assisted type III radical hysterectomy with pelvic lymph node dissection compared with open radical hysterectomy. Am J Obstet Gynecol 2008; 199:357.e1.
  51. Ko EM, Muto MG, Berkowitz RS, Feltmate CM. Robotic versus open radical hysterectomy: a comparative study at a single institution. Gynecol Oncol 2008; 111:425.
  52. Geisler JP, Orr CJ, Khurshid N, et al. Robotically assisted laparoscopic radical hysterectomy compared with open radical hysterectomy. Int J Gynecol Cancer 2010; 20:438.
  53. Kruijdenberg CB, van den Einden LC, Hendriks JC, et al. Robot-assisted versus total laparoscopic radical hysterectomy in early cervical cancer, a review. Gynecol Oncol 2011; 120:334.
  54. Fanning J, Andrews S. Early postoperative feeding after major gynecologic surgery: evidence-based scientific medicine. Am J Obstet Gynecol 2001; 185:1.
  55. Covens A, Rosen B, Murphy J, et al. Changes in the demographics and perioperative care of stage IA(2)/IB(1) cervical cancer over the past 16 years. Gynecol Oncol 2001; 81:133.
  56. Covens A, Rosen B, Gibbons A, et al. Differences in the morbidity of radical hysterectomy between gynecological oncologists. Gynecol Oncol 1993; 51:39.
  57. Zullo MA, Manci N, Angioli R, et al. Vesical dysfunctions after radical hysterectomy for cervical cancer: a critical review. Crit Rev Oncol Hematol 2003; 48:287.
  58. Carenza L, Nobili F, Giacobini S. Voiding disorders after radical hysterectomy. Gynecol Oncol 1982; 13:213.
  59. Seski JC, Diokno AC. Bladder dysfunction after radical abdominal hysterectomy. Am J Obstet Gynecol 1977; 128:643.
  60. Bandy LC, Clarke-Pearson DL, Soper JT, et al. Long-term effects on bladder function following radical hysterectomy with and without postoperative radiation. Gynecol Oncol 1987; 26:160.
  61. Monk, BJ, Tewari, KS. Invasive cervical cancer. In: Clinical Gynecologic Oncology, 7th ed, DiSaia, PJ, Creasman, WT (Eds), Mosby Elsevier, Philadelphia 2007. p. 81.
  62. Brooks RA, Wright JD, Powell MA, et al. Long-term assessment of bladder and bowel dysfunction after radical hysterectomy. Gynecol Oncol 2009; 114:75.
  63. Montz FJ, Holschneider CH, Solh S, et al. Small bowel obstruction following radical hysterectomy: risk factors, incidence, and operative findings. Gynecol Oncol 1994; 53:114.
  64. Al-Sunaidi M, Tulandi T. Adhesion-related bowel obstruction after hysterectomy for benign conditions. Obstet Gynecol 2006; 108:1162.
  65. Mann WJ, Vogel F, Patsner B, Chalas E. Management of lymphocysts after radical gynecologic surgery. Gynecol Oncol 1989; 33:248.
  66. Whitney CW, Stehman FB. The abandoned radical hysterectomy: a Gynecologic Oncology Group Study. Gynecol Oncol 2000; 79:350.
  67. Bremer GL, van der Putten HW, Dunselman GA, de Haan J. Early stage cervical cancer: aborted versus completed radical hysterectomy. Eur J Obstet Gynecol Reprod Biol 1992; 47:147.