Peritoneal Mesometrial Resection (PMMR) with Therapeutic Lymphadenectomy (tLNE) in Endometrial Cancer

PMMR (peritoneal mesometrial resection) is the surgical equivalent to TMMR (total mesometrial resection) in endometrial cancer and has first been described in detail in 2013. Principles of compartmental surgery and differences of the surgical approach due to the different subcompartment of tumour origin are outlined in short: With respect to the tumour bearing subcompartment of uterine corpus, there is no drainage to the ligamentous mesometrium (i.e. sacrouterine ligament) and nodes of the sacrouterine and preischiadic region. Thus, neither the ligamentous mesometrium nor the preischiadic nodes have to be dissected; on the other hand, there is drainage from the fundus along the mesonephric ovarian vessel system suggesting complete resection of these structures including the para-aortic mesenteric lymph nodes being first-order regional lymph compartments on the basis of the concept of compartmental surgery. There is first evidence that compartmental also in endometrial cancer is able to reduce locoregional recurrence even in absence of radiotherapy. The technique, first results and future perspectives are summarized.