Total mesometrial resection for the treatment of cervical cancer – an exploratory study of feasibility, safety and oncological outcomes in developing countries
Total mesometrial resection (TMMR) has shown excellent locoregional control for treatment of cervical cancer without adjuvant radiation therapy in highly selected centers. However, this procedure was never evaluated in resource-limited setting. We hypothesized that the procedure can be reproduced outside the university centers without compromising results. This is a retrospective, observational, multicenter cohort study of patients with IB1-IIB cervical cancer who underwent TMMR in developing countries and omitted adjuvant radiation therapy. A total of 124 patients who met the inclusion criteria were identified between 2015 and 2024 in three centers. The median follow-up was 29 months. The relapse rate was 6.1% (2 out of 33) for IB1, 3% (1 out of 33) for IB2, 11.1% (2 out of 18) for IB3, 20% (1 out of 5) for IIA1, and 16% (6 out of 24) for node-positive patients. No relapses were detected among IIA2 and IIB stages (3 and 8 patients, respectively). There was no significant difference (P = 0.36) in the relapse rate between patients who met the Sedlis criteria (2.9%) and those who did not (8.8%). According to the study, TMMR outcomes can be reproduced without compromising oncologic outcomes. However, prospective evaluation, longer follow-up and a larger cohort are needed to confirm these preliminary data.