The History of Radical Hysterectomy

Abstract

Carcinoma of the uterine cervix provides one of the few examples in medical history of a method of treatment that was once discarded by most of the medical profession and was later reclaimed. In addition, radical hysterectomy (RH) competed with radical vaginal hysterectomy during the early history of RH. The primitive form of RH was first described by Clark and Reis in 1895. Radical hysterectomy was then described in detail and performed by Wertheim, more than 100 years ago. Afterward, RH was abandoned for the treatment of carcinomas because of the use of radiotherapy; however, RH was then modified and repopularized by Meigs in the 1950s. The surgical principles of this operation have undergone only minor modifications throughout the years and remained the basis of the surgical approach used by gynecologic oncologists today. The history of the treatment of cervical carcinoma and the history of RH are unique in medicine. Because of the efforts of the surgeons and scientists, cervical carcinoma has become rarer, and its mortality rate has decreased, although it is still common in undeveloped countries. The history of the treatment of cervical carcinoma includes 3 Nobel Prize winners and 1 Nobel Prize nominee. We therefore think that knowledge of the historical development of this filed will inspire and contribute to the education of future generations. In this article, the historical development of the surgical treatment of cervical carcinoma, the contributors to this surgical procedure, and the pioneers of the surgical and medical treatment of cervical carcinoma are summarized; pictures and illustrations are also provided. Our aim was to inform the gynecologic oncology community about the pioneers that devoted their professional lives to develop of these techniques.

Jejunal torsion around the right ureter presenting as postoperative bowel obstruction: a case report

“…Radical hysterectomy and pelvic lymph node dissection have been considered as the standard surgical treatment for cervical cancer for more than 100 years [7]. In 1905, Wertheim reported a mortality rate of 18 percent and a major morbidity rate of 31 percent for the first 270 patients treated by radical hysterectomy [1,2,7-9].…”

“…In 1905, Wertheim reported a mortality rate of 18 percent and a major morbidity rate of 31 percent for the first 270 patients treated by radical hysterectomy [1,2,7-9]. Since that time, radical hysterectomy with pelvic lymphadenectomy has been performed with modifications in surgical technique as the major surgical treatment for cervical cancer.…”

“…ARH was then detailed, widely described and performed by Wertheim more than 100 years ago [7]. Radical hysterectomy involves the removal of the cervix, uterus and supporting tissues, with pelvic lymphadenectomy and removal of the upper third of the vagina.…”

Comparison of different classifications of radical hysterectomies: Complexifying or helping our understanding?

“…Еще в 1898 г. E. Wertheim выполнил первую абдоминальную расширен-ную гистерэктомию, открыв новую эру в хирургическом лечении РШМ [1]. А в 1912 г. автор уже опубликовал монографию, где был представлен наиболее полный опыт применения этой операции у 500 больных инвазивным РШМ, получившей впоследствии на-звание операция Вертгейма [2].…”

A Novel and Objective Pathological Classification System for Radical Hysterectomy (RH)

“…1 Although hysterectomy was first performed in the early 1800s and RH was described in 1910, hysterectomy classifications were first suggested in the 1970s. 2 In the 1990s and 2000s, fertility-sparing surgery, nerve-sparing surgery, and sentinel lymph node concepts and more radical types of exenteration, including laterally extended endopelvic resection and laterally extended parametrectomy, were proposed for early-and late-stage cervical carcinomas, which have since been incorporated into the surgical management of cervical carcinomas; 3 however, classification of RH was not updated until 2005. Furthermore, although new suggested classification systems have more clearly described the steps of RH, none has included all the aforementioned concepts nor provides more objective rules and quality assurance criteria for use in daily clinical practice.…”