The 2017 version of the Querleu-Morrow (Q-M) classification is effective at identifying radical hysterectomy extent, according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- The 2017 version of the Querleu-Morrow (Q-M) classification proves effective in identifying the extent of radical hysterectomy, as highlighted in a recent study published in the American Journal of Obstetrics & Gynecology.
- Cervical cancer remains a significant global health concern, with 604,127 new cases reported worldwide in 2020, ranking as the fourth most common cancer in women. Early-stage cases often undergo open surgery, with guidelines recommending thorough documentation, including parametrial resection descriptions.
- The Q-M classification is endorsed by prominent medical organizations such as the European Society of Gynecologic Oncology and the National Comprehensive Cancer Network. It provides a standardized framework for describing radical hysterectomy extent, aiming to unify surgical terminology.
- Researchers conducted a study to establish consensus on naming, defining, and interpreting the 2017 Q-M classification. This involved developing specific questions regarding excision lines and comparing different radical hysterectomy types using imaging and online surveys.
- The study results indicate a high level of consensus among experts regarding the classification of radical hysterectomies based on anatomically and surgically relevant structures. This consensus underscores the importance of precise descriptions of excision lines to enhance surgical clarity and standardization.
There were 604,127 new cervical cancer cases worldwide in 2020, making it the fourth most common incidence and cancer-related mortality among women. Early-stage disease is often managed through open surgery, with a description of parametrial resection in the surgical report recommended by the European Society of Gynecologic Oncology (ESGO).
The Q-M classification is used by the ESGO and the National Comprehensive Cancer Network to describe radical hysterectomy extent. The original article describing Q-M classification has been cited as an indicator of surgeon interest in unifying terminology for describing the extent of radical hysterectomy.
Investigators conducted a study to determine a consensus in naming, defining, and interpreting the 2017 of the Q-M classification. Thirteen questions were developed, with questions 1 and 2 discussing the excision line of the vesicouterine ligament, questions 3 to 5 the lateral extent, and questions 6 and 7 the excision line of the rectovaginal ligament.
Radical hysterectomy types were compared through a second set of images, with type A addressed in question 8, simple hysterectomy compared with type A in question 9, type B in question 10, type C in question 11, type B2 in question 12, and type C2 in question 13. The online survey tool SurveyMonkey was used to conduct surveys.
All questions had a yes or no responses. Participants were allowed to explain why they selected no to a question with up to 150 words. The first round of the survey was from January 10, 2022, to February 15, 2022. Feedback was applied for the second round, which took place from March 3, 2022, to June 15, 2022.
There were 29 patients who completed the study. Of participants, 90% approved of the ventral excision line defining partial excision and 97% excision at the bladder of the vesicouterine ligament.
The lateral excision line was approved halfway between the cervix and ureter line for a type A by 93% of participants, at the ureter for a type B by 100%, and at the iliac vessels for a type C radical hysterectomy by 93%. For the dorsal excision line, 93% of participants approved defining at the rectum and 86% at the partial excision of the rectovaginal ligament.
The synthesis of type A radical hysterectomy was approved by 90% of participants, and the separation of a simple hysterectomy as not including paracervical or parauterine tissue by 97%. For types B, C, B2, and C2 radical hysterectomy, the synthesis was approved by 97%, 100%, 90%, and 97% of participants, respectively.
These results indicated high consensus on radical hysterectomies classification among experts. Investigators concluded radical hysterectomy classification should “be based on anatomically and surgically relevant structures and must describe, with the most possible precision, the excision lines in all directions.”
Reference
Querleu D, Cibula D, Abu-Rustum NR, et al. International expert consensus on the surgical anatomic classification of radical hysterectomies. Am J Obstet Gynecol. 2024;230:235.e1-8. doi:10.1016/j.ajog.2023.09.099
