Wertheim operation (radical hysterectomy)

Wertheim operation is a surgical intervention during which the uterus is removed along with the cervix, the upper part of the vagina, and surrounding tissues. Pelvic lymph nodes are also removed if indicated. The operation is most often performed for cervical cancer in its early stages, when the tumor can be completely removed surgically. The extent of the intervention is determined individually depending on the stage of the disease.

At the Oxford Medical medical center in Kyiv, operations are performed by experienced gynecologic oncology surgeons. The intervention is performed in modern operating rooms equipped with expert-class equipment. After the intervention, patients remain under round-the-clock medical supervision in comfortable single or double rooms.

To schedule a consultation with a gynecologic oncologist, call the Oxford Medical contact center or submit a request on the website. The doctor will evaluate the examination results and explain the possible treatment options.

The main indication for Wertheim operation is cervical cancer in its early stages, when the malignant tumor can be completely removed surgically. Most often, such an intervention is considered at stages IB1, IB2, and IIA1.

Doctors at Oxford Medical explain: cancer cells can spread from the cervix into surrounding tissues, even if these changes are not yet noticeable during examination. Therefore, the operation involves removal of the uterus together with the cervix, the upper part of the vagina, and the tissues surrounding the uterus. This makes it possible to remove the tumor with a margin of healthy tissues and reduce the risk of leaving malignant cells behind.

According to the recommendations of the European Society of Gynaecological Oncology (ESGO), the extent of surgical intervention is determined depending on the size of the tumor, the depth of its invasion, and the risk of disease spread. For small tumors with low risk, less radical interventions are sometimes possible, so removal of the uterus is not necessary for all patients with cervical cancer.

Wertheim operation is not suitable for all patients with cervical cancer. Performing it may be inadvisable if the tumor has spread significantly beyond the cervix or the woman's health condition does not allow her to safely undergo major surgical intervention.

The main contraindications to the operation:

• distant metastases in the lungs, liver, or other organs;
• spread of the tumor to the tissues surrounding the uterus or the pelvic walls;
• confirmed metastatic involvement of the pelvic lymph nodes;
• severe concomitant diseases that significantly increase the risk of surgical intervention and anesthesia.

According to Guidelines for the management of patients with cervical cancer, in advanced forms of cervical cancer, chemoradiation therapy is often the main treatment method. It may be used instead of radical surgery if surgical intervention is inadvisable. At the same time, after Wertheim operation, radiation therapy or its combination with chemotherapy may also be prescribed if histological examination has revealed a high risk of disease recurrence. The final treatment strategy is determined individually, taking into account the stage of cancer, examination results, and the patient's general condition.

After the Wertheim operation, the patient usually stays in the hospital for 5–7 days, sometimes longer. During this time, doctors monitor the healing of postoperative wounds, bladder function, and general health condition. Painkillers are prescribed to reduce pain, and to prevent thrombosis, it is recommended to start walking as early as possible, as soon as the patient's condition allows.

A particular feature of recovery after extended uterine extirpation is temporary urinary disturbances. During the operation, nerves that control bladder function may be affected, so a urinary catheter is used during the first few days. It is removed after assessing the patient's ability to empty the bladder independently. In some cases, more time is needed to restore this function.

After discharge, doctors recommend:

• avoiding lifting heavy objects, strength training, and abdominal muscle exercises for 6–8 weeks;
• taking short walks every day, gradually increasing their duration;
• abstaining from sexual intercourse until the internal sutures have healed and the doctor gives permission, usually for at least 6–8 weeks;
• not using tampons or performing vaginal douching during the healing period;
• following recommendations for postoperative wound care and attending follow-up examinations.

Full recovery after the Wertheim operation usually takes 6–8 weeks, although returning to normal activity may require more time. The duration depends on the extent of the intervention, the course of healing, and the need for further oncological treatment.

Doctors at Oxford Medical emphasize: an increase in temperature, increasing pain, heavy bleeding, or inability to empty the bladder independently after catheter removal require urgent medical attention.

Wertheim operation is a complex surgical intervention after which certain complications are possible. Their risk depends on the extent of the disease, the scope of the operation, and the patient's general health condition.

Possible postoperative complications include:

• bleeding during or after the operation;
• infection of the postoperative wound or pelvic organs;
• temporary or prolonged urinary disturbances;
• formation of blood clots in the veins of the lower extremities;
• lymphedema — swelling of the legs due to impaired lymph drainage after removal of the pelvic lymph nodes;
• lymphocele — accumulation of lymphatic fluid in the pelvis.

In addition to possible complications, extended uterine extirpation has certain irreversible consequences associated with the removal of reproductive organs.

Wertheim operation — consequences for the body:

• after removal of the uterus, menstruation stops, and it becomes impossible to become pregnant naturally and carry a child;
• if the ovaries are preserved, they may continue to produce sex hormones, so the body's hormonal function is usually preserved;
• when both ovaries are removed in women of reproductive age, the level of sex hormones decreases sharply and symptoms of menopause appear;
• due to changes in the anatomy of the vagina and surrounding tissues, dryness, discomfort during sexual intercourse, or changes in sensitivity are possible.

Doctors at Oxford Medical recommend undergoing regular follow-up examinations after the operation to assess tissue healing and detect complications in a timely manner. Subsequently, it is important to remain under the supervision of a gynecologic oncologist to monitor treatment results and detect a possible recurrence of the disease in a timely manner.

The price of Wertheim operation depends on the extent of the surgical intervention and its complexity. You can preliminarily ознакомиться with the prices of medical services here. The surgeon will be able to determine the exact cost after studying the examination results and determining the necessary extent of the operation. To schedule a consultation with a gynecologic oncologist, call the Oxford Medical contact center or use the online appointment form on the website.

The information is for informational purposes only and does not replace a doctor's consultation.

Sources:

• European Society of Gynaecological Oncology
• US National Library of Medicine
• The New England Journal of Medicine