{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:07:01Z","timestamp":1778155621633,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T00:00:00Z","timestamp":1625184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>The current understanding of radical hysterectomy more is centered on the uterus and little is being discussed about the resection of the vaginal cuff and the paracolpium as an essential part of this procedure. This is because that the current classifications of radical hysterectomy are based only on the lateral extent of resection. This way is easier to be understood but does not reflect the anatomical and surgical conception of radical hysterectomy and the three-dimensional ways of tumour spreading, neither meet the need of adjusting the radicality according to the different stages of FIGO classification, which depends\u2014at least in the early stages\u2014on the tumour volume and the infiltration in the vagina (but not on the directly spread in the parametrium). The new classification presented in this paper does not base anymore on the lateral extent of resection only but too on the depth of resection in the small pelvic and the extent of the resected vaginal vault without or with its three-dimensional paracolpium. This classification takes into account the tumour size, stage, localization and infiltration in the vaginal vault and may offer the optimal tool to adjust and tailor the surgery according to these important variables.<\/jats:p>","DOI":"10.3390\/cancers13133326","type":"journal-article","created":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T10:06:34Z","timestamp":1625220394000},"page":"3326","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["A New Anatomic and Staging-Oriented Classification of Radical Hysterectomy"],"prefix":"10.3390","volume":"13","author":[{"given":"Mustafa Zelal","family":"Muallem","sequence":"first","affiliation":[{"name":"Department of Gynecology with Center for Oncological Surgery, Charit\u00e9\u2014Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charit\u00e9 Medical University, 13353 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,2]]},"reference":[{"key":"ref_1","first-page":"265","article-title":"Five classes of extended hysterectomy for women with cervical cancer","volume":"44","author":"Piver","year":"1974","journal-title":"Obs. Gynecol"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1470-2045(08)70074-3","article-title":"Classification of radical hysterectomy","volume":"9","author":"Querleu","year":"2008","journal-title":"Lancet Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/ijgo.12749","article-title":"Revised FIGO staging for carcinoma of the cervix uteri","volume":"145","author":"Bhatla","year":"2019","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1136\/ijgc-2019-000410","article-title":"Nerve-sparing radical hysterectomy: Steps to standardize surgical technique","volume":"29","author":"Muallem","year":"2019","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Muallem, M.Z., Armbrust, R., Neymeyer, J., Miranda, A., and Muallem, J. (2020). Nerve Sparing Radical Hysterectomy: Short-Term Oncologic, Surgical, and Functional Outcomes. Cancers, 12.","DOI":"10.3390\/cancers12020483"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1136\/ijgc-2020-001607","article-title":"Nerve-sparing radical hysterectomy\u2014Muallem technique with explanation of parametrium and paracolpium precise anatomy","volume":"31","author":"Muallem","year":"2021","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_7","first-page":"138","article-title":"Local spread and lymph node involvement in cervical cancer","volume":"52","author":"Burghardt","year":"1978","journal-title":"Obstet. Gynecol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1002\/(SICI)1097-0142(20000515)88:10<2267::AID-CNCR10>3.0.CO;2-9","article-title":"Early cervical carcinoma: The natural history of lymph node involvement redefined on the basis of thorough parametrectomy and giant section study","volume":"88","author":"Maneschi","year":"2000","journal-title":"Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.ygyno.2006.07.041","article-title":"Precise anatomy of the vesico-uterine ligament for radical hysterectomy","volume":"104","author":"Fujii","year":"2007","journal-title":"Gynecol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Muallem, M.Z., J\u00f6ns, T., Seidel, N., Sehouli, J., Diab, Y., and Querleu, D. (2020). A Concise Paradigm on Radical Hysterectomy: The Comprehensive Anatomy of Parametrium, Paracolpium and the Pelvic Autonomic Nerve System and Its Surgical Implication. Cancers, 12.","DOI":"10.3390\/cancers12071839"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.ygyno.2011.04.029","article-title":"New classification system of radical hysterectomy: Emphasis on a three-dimensional anatomic template for parametrial resection","volume":"122","author":"Cibula","year":"2011","journal-title":"Gynecol. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1002\/(SICI)1097-0185(19990415)257:2<50::AID-AR4>3.0.CO;2-W","article-title":"Terminologia anatomica: New terminology for the new anatomist","volume":"257","author":"Whitmore","year":"1999","journal-title":"Anat. Rec."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/j.ajog.2005.05.007","article-title":"Terminologia Anatomica versus unofficial descriptions and nomenclature of the fasciae and ligaments of the female pelvis: A dissection-based comparative study","volume":"193","author":"Ercoli","year":"2005","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/0090-8258(89)90143-1","article-title":"The importance of parametrial lymph nodes in the treatment of cervical cancer","volume":"34","author":"Girardi","year":"1989","journal-title":"Gynecol. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1136\/ijgc-00009577-200311000-00030","article-title":"Laterally extended parametrectomy (LEP), the technique for radical pelvic sidewall dissection: Feasibility, technique, and results","volume":"13","author":"Palfalvi","year":"2003","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1006\/gyno.2002.6588","article-title":"Modified radical vaginal hysterectomy with or without laparoscopic nerve-sparing dissection: A comparative study","volume":"85","author":"Querleu","year":"2002","journal-title":"Gynecol. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1007\/s00192-012-1819-7","article-title":"Anatomy and histology of apical support: A literature review concerning cardinal and uterosacral ligaments","volume":"23","author":"Ramanah","year":"2012","journal-title":"Int. Urogynecol. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"4386","DOI":"10.1007\/s00464-013-3043-z","article-title":"Neuro-anatomy of the posterior parametrium and surgical considerations for a nerve-sparing approach in radical pelvic surgery","volume":"27","author":"Ceccaroni","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.3802\/jgo.2019.30.e30","article-title":"Tailoring radicality in early cervical cancer: How far can we go?","volume":"30","author":"Mom","year":"2019","journal-title":"J. Gynecol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1056\/NEJMoa1806395","article-title":"Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer","volume":"379","author":"Ramirez","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1136\/ijgc-2019-000388","article-title":"Laparoscopic radical hysterectomy with transvaginal closure of vaginal cuff\u2014A multicenter analysis","volume":"29","author":"Kohler","year":"2019","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1111\/aogs.13681","article-title":"Peritoneal contamination with ICG-stained cervical secretion as surrogate for potential cervical cancer tumour cell dissemination: A proof-of-principle study for laparoscopic hysterectomy","volume":"98","author":"Klapdor","year":"2019","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.3802\/jgo.2020.31.e7","article-title":"Selection criteria and colpotomic approach for safe minimally invasive radical hysterectomy in early-stage cervical cancer","volume":"31","author":"Kong","year":"2020","journal-title":"J. Gynecol. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1016\/j.ejso.2018.01.092","article-title":"Robotic versus laparoscopic radical hysterectomy in early cervical cancer: A case matched control study","volume":"44","author":"Gallotta","year":"2018","journal-title":"Eur. J. Surg. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/13\/3326\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:25:03Z","timestamp":1760163903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/13\/13\/3326"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,2]]},"references-count":24,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["cancers13133326"],"URL":"https:\/\/doi.org\/10.3390\/cancers13133326","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,2]]}}}