Standard radical volume
Category I - the tumor is limited to the organ: Wertheim/Piver II–III technique with isolation of the ureters to the bladder, intersection of the parametria at the pelvic wall and systematic removal of the external, internal iliac and obturator lymph nodes (12+ nodes). Nerve-sparing elements preserve bladder function. In younger stages of endometrial cancer, lymph node dissection is performed according to risk criteria (depth of invasion, grade). Further treatment is based on histology: clear margins and negative nodes often mean only observation.
Indications
- cervical cancer IA2–IIA — radical hysterectomy with pelvic lymph node dissection (Wertheim procedure);
- endometrial cancer - extirpation with appendages and lymph node dissection according to risk;
- ovarian cancer - cytoreductive interventions as part of complex treatment;
- vaginal cancer - radical removal with lymph node dissection;
- atypical hyperplasia with impossibility of organ preservation.
Principles of radical surgery
Oncological gynecological surgery differs from a conventional hysterectomy in volume: the tumor is removed with surrounding tissues (parameters, vaginal cuff) and lymphatic drainage pathways as a single block - this is the radicality that determines the prognosis. The number and condition of removed lymph nodes stages the disease and resolves the issue of postoperative radiation/chemotherapy. The price categories reflect the complexity: involvement of neighboring organs, the need for ureteral stenting, prevalence. The operations are performed by a gynecological oncology team with high-level anesthesiological support.
