Understanding Anterior Parametrectomy for Preventing Local and Pelvic Recurrences in Cervical Cancer - an Answer to Failure of LACC Trial

Study Objective This video is a demonstration of the anatomy of parametrium and its significance in radical hysterectomy in cervical cancer. Design Video Demonstration. Setting It includes a case of ca cervix stage IB undergoing nerve sparing radical hysterectomy with complete parametrectomy. The dissection of posterior and lateral parametrium is technically easier as compared to that of anterior parametrium. Anteriorly and posteriorly, protection to the spread of cervical cancer is provided by the cervico-vesical fascia and Denonvilliers fascia respectively. Deficiency or the weakest area facilitating tumor spread lies on the lateral aspects as the cervico- vesical ligaments and their incomplete removal leads to local and pelvic recurrences. Patients or Participants 60-year-old with post-menopausal bleeding & cervical biopsy squamous cell carcinoma. FIGO stage IB2. Interventions Understanding the anatomy of parametrium is an important step to achieve optimum tumor clearance. “Lymphatics follow the veins”, was the dictum that led to the origin for the need of parametrectomy in this radical procedure. Schematic diagrams depict the various extents of the parametrium in the three-dimensional scenario. The inferior vesical vein is ligated around two centimeters lateral to the lateral border of vagina making it the lateral extent on either side enforcing complete parametrial clearance. Meticulous and careful dissection of the ureter, achieving hemostasis and preserving the innervation were the various challenges encountered during the procedure. Laparoscopy with its magnified vision and a thorough knowledge of anatomy can achieve a complete parametrectomy. Measurements and Main Results Mean operative time 80 minutes. Blood loss 100ml. Conclusion Thus, this video makes an effort in understanding the anatomy of anterior parametrium. The failure to recognize it or incompetence to achieve it leads to higher rates of recurrences and lower survival rates in minimally invasive approach for cervical cancer as highlighted in the LACC trial. This video is a demonstration of the anatomy of parametrium and its significance in radical hysterectomy in cervical cancer. Video Demonstration. It includes a case of ca cervix stage IB undergoing nerve sparing radical hysterectomy with complete parametrectomy. The dissection of posterior and lateral parametrium is technically easier as compared to that of anterior parametrium. Anteriorly and posteriorly, protection to the spread of cervical cancer is provided by the cervico-vesical fascia and Denonvilliers fascia respectively. Deficiency or the weakest area facilitating tumor spread lies on the lateral aspects as the cervico- vesical ligaments and their incomplete removal leads to local and pelvic recurrences. 60-year-old with post-menopausal bleeding & cervical biopsy squamous cell carcinoma. FIGO stage IB2. Understanding the anatomy of parametrium is an important step to achieve optimum tumor clearance. “Lymphatics follow the veins”, was the dictum that led to the origin for the need of parametrectomy in this radical procedure. Schematic diagrams depict the various extents of the parametrium in the three-dimensional scenario. The inferior vesical vein is ligated around two centimeters lateral to the lateral border of vagina making it the lateral extent on either side enforcing complete parametrial clearance. Meticulous and careful dissection of the ureter, achieving hemostasis and preserving the innervation were the various challenges encountered during the procedure. Laparoscopy with its magnified vision and a thorough knowledge of anatomy can achieve a complete parametrectomy. Mean operative time 80 minutes. Blood loss 100ml. Thus, this video makes an effort in understanding the anatomy of anterior parametrium. The failure to recognize it or incompetence to achieve it leads to higher rates of recurrences and lower survival rates in minimally invasive approach for cervical cancer as highlighted in the LACC trial.