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Principles and Practice of Surgery in Gynaecological Cancer

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Fundamentals in Gynaecologic Malignancy

Abstract

Surgical oncology pertains to the application of oncological principles to surgically treat patients with cancer. A surgical oncologist is often the first specialist a patient with a possible diagnosis of cancer encounters and is responsible for a comprehensive clinical assessment. In that context, the clinical methods of a surgical oncologist assume paramount importance and a lot depends on the level of knowledge of the specialist regarding all existing therapies, whether surgical or non-surgical and standard or experimental. The term surgical oncology includes in its domain, by a broad definition, all the disciplines of surgery which are concerned with the treatment of cancer. This inclusive nature of the subject is owing to the fact that there are relatable surgical principles, regarded as oncologically sound, which are applicable to cancers arising from various organ systems of the body.

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References

  1. Faguet GB. A brief history of cancer: age-old milestones underlying our current knowledge database. Int J Cancer. 2015;136(9):2022–36. https://doi.org/10.1002/ijc.29134.

    Article  CAS  Google Scholar 

  2. Bean WB. The century of the surgeon. AMA Arch Intern Med. 1959;103(3):506–7. https://doi.org/10.1001/archinte.1959.00270030162020.

    Article  Google Scholar 

  3. Robinson DH, Toledo AH. Historical development of modern anesthesia. J Invest Surg. 2012;25(3):141–9. https://doi.org/10.3109/08941939.2012.690328. PMID: 22583009.

    Article  Google Scholar 

  4. Worboys M. Joseph Lister and the performance of antiseptic surgery. Notes Rec R Soc Lond. 2013;67(3):199–209. https://doi.org/10.1098/rsnr.2013.0028.

    Article  Google Scholar 

  5. Titford M. A short history of histopathology technique. J Histotechnol. 2006;29(2):99–110. https://doi.org/10.1179/his.2006.29.2.99.

    Article  Google Scholar 

  6. Lawrence W. History of surgical oncology. In: Norton JA, et al., editors. Surgery. New York: Springer; 2008. https://doi.org/10.1007/978-0-387-68113-9_90.

    Chapter  Google Scholar 

  7. Buesa RJ, Peshkov MV. How much formalin is enough to fix tissues? Ann Diagn Pathol. 2012;16(3):202–9. https://doi.org/10.1016/j.anndiagpath.2011.12.003. Epub 2012 Apr 5. PMID: 22483550.

    Article  Google Scholar 

  8. Brierley J, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. Chichester: Wiley; 2017.

    Google Scholar 

  9. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345:745–8.

    Article  CAS  Google Scholar 

  10. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49. https://doi.org/10.1016/S1470-2045(10)70070-X. Epub 2010 Apr 19. PMID: 20409751.

    Article  Google Scholar 

  11. Cuschieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet. 1996;347:995–9.

    Article  CAS  Google Scholar 

  12. Kampschoer GH, Maruyama K, van de Velde CJ, et al. Computer analysis in making preoperative decisions: a rational approach to lymph node dissection in gastric cancer patients. Br J Surg. 1989;76:905–8.

    Article  CAS  Google Scholar 

  13. Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy–Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.

    Article  Google Scholar 

  14. Smith DD, Schwarz RR, Schwarz RE. Impact of total lymph node count on staging and survival after gastrectomy for gastric cancer: data from a large US-population database. J Clin Oncol. 2005;23:7114–24.

    Article  Google Scholar 

  15. Bouvier AM, Haas O, Piard F, et al. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study. Cancer. 2002;94:2862–6.

    Article  Google Scholar 

  16. Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253(5):900–11. https://doi.org/10.1097/SLA.0b013e318212bff6. PMID: 21394009.

    Article  Google Scholar 

  17. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24(1):1–21. https://doi.org/10.1007/s10120-020-01042-y. Epub 2020 Feb 14. PMID: 32060757; PMCID: PMC7790804.

    Article  Google Scholar 

  18. Emmanuel A, Haji A. Complete mesocolic excision and extended (D3) lymphadenectomy for colonic cancer: is it worth that extra effort? A review of the literature. Int J Colorectal Dis. 2016;31(4):797–804. https://doi.org/10.1007/s00384-016-2502-0. Epub 2016 Jan 30. PMID: 26833471.

    Article  Google Scholar 

  19. Kanemitsu Y, Komori K, Kimura K, Kato T. D3 lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer. Dis Colon Rectum. 2013;56(7):815–24. https://doi.org/10.1097/DCR.0b013e3182919093. PMID: 23739187.

    Article  Google Scholar 

  20. Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.

    CAS  Google Scholar 

  21. Cassidy MR, Gholami S, Strong VE. Minimally invasive surgery: the emerging role in gastric cancer. Surg Oncol Clin N Am. 2017;26:193–212.

    Article  Google Scholar 

  22. Kitano S, Shiraishi N, Fujii K, et al. A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery. 2002;131:S306–11.

    Article  Google Scholar 

  23. Huang KH, Lan YT, Fang WL, et. al. Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg. 2012;16:1303–10.

    Article  Google Scholar 

  24. Hwang SI, Kim HO, Yoo CH, et al. Laparoscopic-assisted distal gastrectomy versus open distal gastrectomy for advanced gastric cancer. Surg Endosc. 2009;23:1252–8.

    Article  Google Scholar 

  25. Kinoshita T, Uyama I, Terashima M, et al. Long-term outcomes of laparoscopic versus open surgery for clinical stage II/III gastric cancer: a multicenter cohort study in Japan (LOC-A study). Ann Surg. 2019;269(5):887–94.

    Article  Google Scholar 

  26. Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg. 2016;263:28–35.

    Article  Google Scholar 

  27. Sakuramoto S, Yamashita K, Kikuchi S, et al. Laparoscopy versus open distal gastrectomy by expert surgeons for early gastric cancer in Japanese patients: short-term clinical outcomes of a randomized clinical trial. Surg Endosc. 2013;27:1695–705.

    Article  Google Scholar 

  28. Yoo CH, Kim HO, Hwang SI, et al. Short-term outcomes of laparoscopic-assisted distal gastrectomy for gastric cancer during a surgeon’s learning curve period. Surg Endosc. 2009;23:2250–7.

    Article  Google Scholar 

  29. Huscher CG, Mingoli A, Sgarzini G, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.

    Article  Google Scholar 

  30. Vinuela EF, Gonen M, Brennan MF, et al. Laparoscopic versus open distal gastrectomy for gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized studies. Ann Surg. 2012;255:446–56.

    Article  Google Scholar 

  31. Chen K, Pan Y, Zhang B, et al. Robotic versus laparoscopic gastrectomy for gastric cancer: a systematic review and updated meta-analysis. BMC Surg. 2017;17:93.

    Article  Google Scholar 

  32. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359(9325):2224–9.

    Article  Google Scholar 

  33. Liang J-T, Huang K-C, Lai H-S, Lee P-H, Jeng Y-M. Oncologic results of laparoscopic versus conventional open surgery for stage II or III leftsided colon cancers: a randomized controlled trial. Ann Surg Oncol. 2007;14(1):109–17.

    Article  Google Scholar 

  34. Fleshman J, Sargent DJ, Green E, Anvari M, Stryker SJ, Beart RW, et al. Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg. 2007;246(4):655–62; discussion 662–4.

    Article  Google Scholar 

  35. Kitano S, Inomata M, Mizusawa J, Katayama H, Watanabe M, Yamamoto S, et al. Survival outcomes following laparoscopic versus open D3 dissection for stage II or III colon cancer (JCOG0404): a phase 3, randomised controlled trial. Lancet Gastroenterol Hepatol. 2017;2(4):261–8.

    Article  Google Scholar 

  36. Jeong S-Y, Park JW, Nam BH, Kim S, Kang S-B, Lim S-B, et al. Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol. 2014;15(7):767–74.

    Article  Google Scholar 

  37. Bonjer HJ, Deijen CL, Haglind E, COLOR II Study Group. A randomized trial of laparoscopic versus open surgery for rectal cancer. N Engl J Med. 2015;373(2):194.

    Article  Google Scholar 

  38. Fleshman J, Branda M, Sargent DJ, Boller AM, George V, Abbas M, et al. Effect of laparoscopic-assisted resection vs open resection of stage II or III rectal cancer on pathologic outcomes: the ACOSOG Z6051 randomized clinical trial. JAMA. 2015;314(13):1346–55.

    Article  CAS  Google Scholar 

  39. Stevenson ARL, Solomon MJ, Lumley JW, Hewett P, Clouston AD, Gebski VJ, et al. Effect of laparoscopic-assisted resection vs open resection on pathological outcomes in rectal cancer: the ALaCaRT randomized clinical trial. JAMA. 2015;314(13):1356–63.

    Article  CAS  Google Scholar 

  40. Prete FP, Pezzolla A, Prete F, Testini M, Marzaioli R, Patriti A, et al. Robotic versus laparoscopic minimally invasive surgery for rectal cancer: a systematic review and meta-analysis of randomized controlled trials. Ann Surg. 2018;267(6):1034–46.

    Article  Google Scholar 

  41. Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol. 1998;16:2672–85.

    Article  CAS  Google Scholar 

  42. Bear HD, Anderson S, Smith RE, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol. 2006;24:2019–27.

    Article  CAS  Google Scholar 

  43. Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet. 2010;375:377–84.

    Article  CAS  Google Scholar 

  44. Untch M, Loibl S, Bischoff J, et al. Lapatinib versus trastuzumab in combination with neoadjuvant anthracycline-taxane-based chemotherapy (GeparQuinto, GBG 44): a randomised phase 3 trial. Lancet Oncol. 2012;13:135–44.

    Article  CAS  Google Scholar 

  45. De Azambuja E, Holmes AP, Piccart-Gebhart M, et al. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): survival outcomes of a randomised, open-label, multicentre, phase 3 trial and their association with pathological complete response. Lancet Oncol. 2014;15:1137–46.

    Article  Google Scholar 

  46. Schneeweiss A, Chia S, Hickish T, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol. 2013;24:2278–84.

    Article  CAS  Google Scholar 

  47. Cochrane RA, Valasiadou P, Wilson ARM, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90(12):1505–9.

    Article  CAS  Google Scholar 

  48. Rainsbury RM. Surgery Insight: oncoplastic breast-conserving reconstruction—indications, benefits, choices and outcomes. Nat Clin Pract Oncol. 2007;4(11):657–64.

    Article  Google Scholar 

  49. Masetti R, Pirulli PG, Magno S, Franceschini G, Chiesa F, Antinori A. Oncoplastic techniques in the conservative surgical treatment of breast cancer. Breast Cancer. 2000;7(4):276–80.

    Article  CAS  Google Scholar 

  50. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol. 2014;15:1303–10.

    Article  Google Scholar 

  51. Giuliano A, Hunt K. Axillary dissection vs. no axillary dissection in women with invasive breast cancer and sentinel node metastasis—Z11. JAMA. 2011;305:569–75.

    Article  CAS  Google Scholar 

  52. Krag DN, Anderson SJ, Julian TB, et al. Sentinel lymph node resection compared with conventional axillary lymph node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol. 2010;11:927–33.

    Article  Google Scholar 

  53. Galimberti V, Cole BF, Zurrida S, et al. Axillary dissection versus no axillary dissection in patients with sentinel-node micrometastases (IBCSG 23-01): a phase 3 randomised controlled trial. Lancet Oncol. 2013;14:297–305.

    Article  Google Scholar 

  54. Landin J, Weber WP. Lymph node surgery—stepwise retirement for the breast surgeon? Breast Care. 2016;11:282–6.

    Article  Google Scholar 

  55. Kuehn T, Bauerfeind I, Fehm T, et al. Sentinel lymph node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol. 2013;14:609–18.

    Article  Google Scholar 

  56. Boughey JC, Suman VJ, Mittendorf EA, et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA. 2013;310:1455–61.

    Article  CAS  Google Scholar 

  57. Mamounas EP, Brown A, Anderson S, et al. Sentinel node biopsy after neoadjuvant chemotherapy in breast cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol B-27. J Clin Oncol. 2005;23:2694–702.

    Article  Google Scholar 

  58. Haffty BG, McCall LM, Ballman KV, et al. Patterns of local-regional management following neoadjuvant chemotherapy in breast cancer: results from ACOSOG Z1071. Int J Radiat Oncol Biol Phys. 2016;94:493–502.

    Article  Google Scholar 

  59. Gentilini O, Veronesi U. Abandoning sentinel lymph node biopsy in early breast cancer? A new trial in progress at the European Institute of Oncology of Milan (SOUND: Sentinel node vs. Observation after axillary UltraSouND). Breast. 2012;21:678–81.

    Article  Google Scholar 

  60. Jatoi I, Benson JR, Toi M. De-escalation of axillary surgery in early breast cancer. Lancet Oncol. 2016;17:e430–41.

    Article  Google Scholar 

  61. Treasure T, Milošević M, Fiorentino F, et al. Pulmonary metastasectomy: what is the practice and where is the evidence for effectiveness? Thorax. 2014;69:946–9.

    Article  Google Scholar 

  62. Morris EJ, Forman D, Thomas JD, et al. Surgical management and outcomes of colorectal cancer liver metastases. Br J Surg. 2010;97:1110.

    Article  CAS  Google Scholar 

  63. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13:8–10.

    Article  CAS  Google Scholar 

  64. Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol. 2010;40:107–11.

    Article  Google Scholar 

  65. Ashworth A, Rodrigues G, Boldt G, Palma D. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer. 2013;82:197–203.

    Article  Google Scholar 

  66. Garber JE, Offit K. Hereditary cancer predisposition syndromes. J Clin Oncol. 2005;23:276–92.

    Article  Google Scholar 

  67. Eisen A, Rebbeck TR, Wood WC, et al. Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer. J Clin Oncol. 2000;18:1980–95.

    Article  CAS  Google Scholar 

  68. Meijers-Heijboer H, van Geel B, van Putten WL, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2001;345:159–64.

    Article  CAS  Google Scholar 

  69. Rebbeck TR, Friebel T, Lynch HT, et al. Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol. 2004;22:1055–62.

    Article  Google Scholar 

  70. Kauff ND, Satagopan JM, Robson ME, et al. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2002;346:1609–15.

    Article  Google Scholar 

  71. Nyam DC, Brillant PT, Dozois RR, et al. Ileal pouch-anal canal anastomosis for familial adenomatous polyposis: early and late results. Ann Surg. 1997;226:514–9.

    Article  CAS  Google Scholar 

  72. Church JM. Prophylactic colectomy in patients with hereditary nonpolyposis colorectal cancer. Ann Med. 1996;28:479–82.

    Article  CAS  Google Scholar 

  73. Syngal S, Weeks JC, Schrag D, et al. Benefits of colonoscopic surveillance and prophylactic colectomy in patients with hereditary nonpolyposis colorectal cancer mutations. Ann Intern Med. 1998;129:787–96.

    Article  CAS  Google Scholar 

  74. Skinner MA, Moley JA, Dilley WG, et al. Prophylactic thyroidectomy in multiple endocrine neoplasia type 2A. N Engl J Med. 2005;353:1105–13.

    Article  CAS  Google Scholar 

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Das, G., Shrikhande, S.V., Chaudhari, V., Kataki, A.C. (2022). Principles and Practice of Surgery in Gynaecological Cancer. In: Kataki, A.C., Barmon, D. (eds) Fundamentals in Gynaecologic Malignancy. Springer, Singapore. https://doi.org/10.1007/978-981-19-5860-1_6

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