Cancer field surgery for locoregional tumor control of cervical carcinoma

Abstract

As the current standard, surgery is applied to treat early-stage cervical cancer and selected post-irradiation pelvic relapses. Surgical therapy for local disease is based on a model of unlimited isotropic cancer cell propagation and dissection artifacts such as subperitoneal “ligaments” and “spaces”. For regional disease, the role of traditional surgery is diagnostic and eventually cytoreductive. However, the isotropic local tumor propagation model has to be rejected due to numerous inconsistencies with clinical facts. Likewise, the “ligament and space” approach to the subperitoneum is too crude and variable to accurately cover both local spread and intercalated lymph node metastases of cervical cancer. The ontogenetic cancer field model is fully in line with the locoregional spread patterns of carcinoma of the female genital tract. Developmentally derived (ontogenetic) anatomy enables unbiased and accurate dissection of the complex tissue structures within the subperitoneum. Cancer field surgery founded on these insights has a high potential to improve the treatment outcome of cervical carcinoma.

Keywords

Cervix carcinoma / radical hysterectomy / local cancer spread / regional cancer spread / ontogenetic anatomy / cancer field surgery / ontogenetic tumor staging

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