Ernst Wertheim (1864–1920) and the operation of Wertheim
© Springer-Verlag 2008
Published: 23 September 2008
The name of this Austrian gynaecologist remains eponymously associated with the radical abdominal hysterectomy for uterine cancer .
This close relationship between the two surgeon specialists came to an end when, in 1899, the 33-year-old Wertheim was appointed director of the Bettina-Pavillon. This gynaecologic–oncologic department of one of Vienna’s hospitals had been founded by the banker-philanthropist Baron Albert Rothschild in memory of his wife Frau Bettina who died of breast cancer. It was a hyper-modern hospital equipped with the latest technology where Wertheim was able to perfect the “Wertheim operation”.
But it is with the “operation of Wertheim” that he has secured his place in medical history. After the pathologists/anatomists had demonstrated during the years 1880 that the collum carcinoma would spread through the surrounding tissues and involve the local lymph nodes much more rapidly than had previously been assumed, it was evident that the practised hysterectomy could not be a curative operation and that a more radical approach was called for. An American gynaecologist from Baltimore, USA, would take the lead and introduce in the year 1895 a “more radical method of performing hysterectomy surgery for uterine cancer” . However, it appeared from his report on the operations of 12 women patients that he had not in all of these cases removed the parametria together with the lymph nodes. For that reason, the honour of having introduced the expanded (“erweiterte”) abdominal operation belongs to Wertheim. He did, indeed, systematically remove the uterus together with the uterine appendages, the upper third of the vagina, the parametria and the pelvic lymph nodes .
All operated specimens were meticulously examined, both macroscopically and microscopically. The fact that, in this manner and at an early stage, he was able to observe in many of them the presence of cancerous tissue outside of the uterus convinced him that his surgical approach and philosophy was correct, and likewise that complete lymphadenectomy could only be achieved via the abdominal route. The 100% follow-up of his enormous patient list (it is estimated that Wertheim performed over 1,300 Wertheim operations) and the statistical analysis of the results, whereby he drew a clear distinction between “primary surgical mortality” and “consistent recovery”, proved the effectiveness of the “Wertheim operation”, the operation that served as a persistent model for all later modifications to the methodology.
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