The Querleu-Morrow (Q-M) classification of radical hysterectomy replaced the Piver-Rutledge-Smith classification. In Q-M Type C1 radical hysterectomy, what specifically distinguishes it from Type C2?

• A Type C1 preserves autonomic nerve supply (nerve-sparing), Type C2 resects hypogastric nerve plexus completely ✓
• B Type C1 resects parametrium at internal iliac vessel, Type C2 resects at external iliac vessel
• C Type C1 requires para-aortic lymphadenectomy, Type C2 requires only pelvic lymphadenectomy
• D Type C1 preserves uterine arteries bilaterally, Type C2 ligates both at origin

Explanation

The Querleu-Morrow (2008) classification divides radical hysterectomy into Types A, B, C, and D based on extent of parametrial resection. Type C is full parametrial resection to the pelvic wall; within Type C, the distinction is: C1 (nerve-sparing) preserves the autonomic hypogastric nerve plexus and pelvic splanchnic nerves (reducing bladder and bowel dysfunction), while C2 (non-nerve-sparing) completely resects these neural structures providing maximum oncological clearance at the cost of higher rates of urinary/bowel dysfunction. This nerve-sparing designation replaced the older Piver Type 3/4 distinction. Parametrial resection levels and uterine artery ligation (B, D) do not differentiate C1 from C2. Lymphadenectomy (C) is not the distinguishing feature.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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