Principle of conventional cancer surgery: Wide tumor excision and staging
lymph node dissection
Traditional surgery for local cancer control is based on functional topographic anatomy confounded by empirical dissection artefacts and on the model of isotropic tumor permeation. The clinical practice translated from these principles is wide tumor excision, i.e. the resection of the tumor with a metrically defined circumferential tissue margin free of neo- or dysplastic lesions. However, that treatment may cause considerable morbidity. Moreover, despite R0 resection, local recurrences that often indicate a poor prognosis may occur in up to 50 percent. Although fundamental for the concept of surgical tumor treatment, the prognostic robustness of margin width could never be demonstrated.
Regional lymph node dissection is performed for nodal staging. In case of proven metastases surgical treatment alone is regarded insufficient for tumor control and adjuvant (chemo)radiation is recommended. Postoperative radiation therapy may reduce locoregional relapses of gynecologic malignancies but overall survival is not improved. Instead, treatment morbidity is significantly increased and a great proportion of patients is overtreated.