Long term survival after mesometrial resection for cervical cancer from the Mesometrial Resection (MMR) Study

Abstract The Leipzig School Mesometrial Resection Study (MMR Study) investigates whether surgical treatment based on stage-associated ontogenetic cancer fields and their corresponding lymphatic compartments can achieve durable locoregional tumor control without adjuvant radiotherapy. This ongoing, prospective, single-center observational cohort study enrolls patients with primary cervical cancer. Depending on ontogenetic tumor stage, patients undergo total mesometrial resection (TMMR) or extended mesometrial resection (EMMR) with therapeutic lymph node dissection. As all locoregional at-risk tissues are surgically removed, adjuvant radiotherapy is omitted. This long-term follow-up analysis included patients FIGO 2009 stages IB1–IIB. Between 1999 and 2020, 543 patients were included, with a median follow-up of 104 months. Disease stages were IB1 (60%), IB2 (11%), IIA1 (4.4%), IIA2 (1.7%), and IIB (23%). Nodal status was pN0 in 72.4% and pN1 in 27.6%. Ten-year recurrence-free survival (RFS) and overall survival (OS) were 84.0% and 84.1%, respectively. Stratified by nodal status, 10-year RFS was 92.6% for pN0 and 60.8% for pN1, while OS was 90.9% and 65.6%, respectively. Multivariable Cox regression showed favorable prognostic stratification for ontogenetic tumor staging compared with conventional pT staging (AIC 928.78 vs. 939.23). TMMR or EMMR with therapeutic lymph node dissection was associated with favorable long-term oncologic outcomes in this cohort. Ontogenetic tumor staging may improve prognostic assessment in cervical cancer.