Mihai Emil Căpîlna1, Lászlo Ungár2, Alexandra Lavinia Cozlea1, Mihai Gheorghe1, Mihai Stanca1, Balázs Lintner3, Andreea Anamaria Moldovan4. 1. First Obstetrics and Gynecology Clinic, G. E. Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania. 2. Department of Gynecology, Duna Medical Center, Budapest, Hungary. 3. Department of Gynecology, Semmelweis University, Budapest, Hungary. 4. Department of Infectious Diseases and Epidemiology, County Hospital, Brașov, Romania.
Abstract
Objective: To describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of the procedure. Methods: LEP was designed as a more radical surgical procedure aiming to remove the entire parametrial tissue from the pelvic side wall. Its initial indications were for lymph node positive Stage Ib (current FIGO 2018 Stage IIIc) and Stage IIb cervical cancer. Currently, with most guidelines recommending definitive radiochemotherapy for these cases, initial LEP indications have become debatable. LEP is now mainly indicated for removing tumors involving the soft structures of the pelvic side wall during a pelvic exenteration, aiming to obtain lateral free margins. This expands the lateral borders of the dissection to not only the medial surface of internal iliac vessels, but also to the true limits of the pelvic side wall. Results: During LEP, the parietal and visceral branches of the hypogastric vessels are divided at the entry and exit level of the pelvis. Consequently, the entire internal iliac system is excised, and no connective or lymphatic tissue remain on the pelvic side wall. The main technical challenges of LEP are caused by the difficulty in ligating large caliber vessels (internal iliac artery and vein) and the variable anatomic distribution of pelvic side wall veins. Conclusion: LEP is a feasible technique for removing pelvic side wall recurrences, aiming to obtain surgical free margins.
Objective: To describe the laterally extended parametrectomy (LEP) surgical technique, emphasizing the main challenges of the procedure. Methods: LEP was designed as a more radical surgical procedure aiming to remove the entire parametrial tissue from the pelvic side wall. Its initial indications were for lymph node positive Stage Ib (current FIGO 2018 Stage IIIc) and Stage IIb cervical cancer. Currently, with most guidelines recommending definitive radiochemotherapy for these cases, initial LEP indications have become debatable. LEP is now mainly indicated for removing tumors involving the soft structures of the pelvic side wall during a pelvic exenteration, aiming to obtain lateral free margins. This expands the lateral borders of the dissection to not only the medial surface of internal iliac vessels, but also to the true limits of the pelvic side wall. Results: During LEP, the parietal and visceral branches of the hypogastric vessels are divided at the entry and exit level of the pelvis. Consequently, the entire internal iliac system is excised, and no connective or lymphatic tissue remain on the pelvic side wall. The main technical challenges of LEP are caused by the difficulty in ligating large caliber vessels (internal iliac artery and vein) and the variable anatomic distribution of pelvic side wall veins. Conclusion: LEP is a feasible technique for removing pelvic side wall recurrences, aiming to obtain surgical free margins.