Super-radical hysterectomy for recurrent cervical cancer

Recurrent cervical cancer with the pelvic side wall invasion has a deleterious effect on prognosis if there is no alternative method to achieve local tumor control [1, 2]. For the surgical treatment, super-radical hysterectomy has been introduced by Ryukichi Mibayashi in 1941 [3, 4]. However, its feasibility and safety is still on debate because of a lack of reproducibility and high level of surgical techniques. Thus, we showed the surgical procedure of super-radical hysterectomy for recurrent cervical cancer.

A 40 year-old woman visited after diagnosis of the pelvic recurrence, who received concurrent chemoradiation before 13 months due to stage IIB cervical cancer. Preoperative examination showed tumor invasion to upper third of the vagina, the right distal ureter and urethra, the posterior bladder wall and the right pelvic wall. Thus, we performed anterior pelvic exenteration with super-radical hysterectomy for removing the right pelvic side wall tumors. First, we ligated the right superior gluteal vessels, and then ligated the right internal iliac vessels. Second, we ligated the right inferior gluteal vessels, and subsequently the right internal pudendal vessels. Third, we resected her genitourinary tract with the right internal iliac vessels around the pelvic floor completely.

The procedure time was 160 minutes, and she underwent subsequent procedures including ileal conduit and omental J flap. She was discharged after 2 weeks without complications.

Super-radical hysterectomy can be considered to be feasible and safe through the step-wise ligation of the internal iliac vessels for recurrent cervical cancer with the pelvic side wall invasion.