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Laterally extended parametrectomy.

Mihai Emil Căpîlna1, Lászlo Ungár2, Alexandra Lavinia Cozlea1

  • 1First Obstetrics and Gynecology Clinic, G. E. Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania.

Obstetrics & Gynecology Science
|May 24, 2021
PubMed
Summary

Laterally extended parametrectomy (LEP) is a surgical technique to remove pelvic sidewall tumors. Key challenges involve ligating large pelvic vessels and managing variable vein anatomy for free margins.

Keywords:
Cervical cancerExcision marginsParametrectomyRecurrences

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Area of Science:

  • Gynecologic Oncology
  • Surgical Oncology

Background:

  • Laterally extended parametrectomy (LEP) was initially indicated for advanced cervical cancer.
  • Current guidelines often favor chemoradiotherapy for these indications, making original LEP use debatable.

Purpose of the Study:

  • To describe the laterally extended parametrectomy (LEP) surgical technique.
  • To highlight the primary challenges encountered during the LEP procedure.

Main Methods:

  • LEP involves radical removal of parametrial tissue to the pelvic sidewall.
  • The technique expands dissection to the medial internal iliac vessels and pelvic sidewall limits.
  • LEP is now primarily used in pelvic exenteration for tumors involving pelvic sidewall soft structures.

Main Results:

  • LEP entails dividing hypogastric vessels, excising the internal iliac system, and clearing connective/lymphatic tissue.
  • Major challenges include ligating the internal iliac artery and vein.
  • Variable pelvic sidewall vein anatomy presents a significant technical difficulty.

Conclusions:

  • Laterally extended parametrectomy (LEP) is a viable surgical option.
  • LEP facilitates the removal of pelvic sidewall recurrences.
  • The technique aims to achieve crucial surgical free margins in complex cases.