دانلود کتاب جراحی میدانی سرطان در انکولوژی زنان

This book project marks a state in a long-term scientific and clinical enterprise that has achieved insights and results to be structured and summarized. When it became apparent that traditional concepts of local cancer progression had to be abandoned due to incompatibilities with clinical facts, a new approach, the ontogenetic cancer field model, evolved. Pursuing the development of the female reproductive system to map its ontogenetic anatomy provided clues for local spread patterns of lower genital tract carcinomas. The model unveils a so far hidden order of cancer: Tumors propagate locally within tissues, which are determined by successive de-differentiation of the cancer cells, a reversion of the corresponding normal cell type’s differentiation trajectory during morphogenesis. This model stringently explains the discrepancies in the traditional isotropic cancer spread concept. Moreover, a precise understanding of the complex anatomy of the subperitoneum and a different view on the perineum arose from the study of their ontogenetic pathways. It renders the conventional surgical anatomy of dissection-driven artifacts and arbitrary tissue boundaries obsolete. Linking the cancer field model to mechanisms of peripheral immune tolerance of normal and transformed cells and respecting the network architecture of the lymphatic system based on its development allowed an unequivocal interpretation of the pattern of lymph nodal metastasis with regard to first, second, and third immunologic defense lines as observed with carcinomas of the lower genital tract. The clinical translation of this new paradigm of ontogenetic cancer fields into ontogenetic cancer staging and cancer field surgery with immunologic defense line- directed lymph node dissection totally dispensing with adjuvant radiotherapy has led to sustainable superior treatment results, now manifested with more than one thousand patients in our centers. Since 2005, the new principles and practice are taught at the Leipzig School of Radical Pelvic Surgery. Many colleagues from all over the world have attended the courses held in Leipzig, Germany, and implemented cancer field surgery in their armamentarium. Each course increased the demand not only of practicing colleagues but also of medical students interested in a deeper understanding of solid cancers to compile the educational contents in a textbook. When the superior results of cancer field surgery passed the test of time and many other centers were able to reproduce them, this book project was finally started. The book aims to fulfill three goals: the reader should (1) understand the logic of the cancer field model, (2) become familiar with the ontogenetic anatomy of the female pelvis and perineum, and (3) be enabled to practice cancer field surgery. Co-authored by Rainer Kimmig, who developed robotic cancer field surgery to treat endometrial cancer, the book introduces the optimal technical approaches available to date to operate gynecologic cancer according to the paradigm. The book is divided into two parts: Basics and Clinics. Although the Basics part provides useful information to practice cancer field surgery by introducing the reader into the paradigm of ontogenetic cancer fields, the comprehension of this rather ambitious text is not essential to become able to reproduce the novel surgical techniques. The Clinics part describes cancer field surgery for the treatment of gynecologic cancer step by step, elucidating all aspects of its perfect performance. Figures in the form of schematic and anatomical drawings as well as photographs are placed at high priority. Two artists, Nikolaus Lechenbauer and Mara Sandrock, accomplished this demanding task with their personal aesthetic signatures to inform and engage the reader. Mara Sandrock and Angela Steller took the step-by-step procedural photographs mastering the challenge of depicting the deep pelvis with highest precision and resolution. The paradigm of ontogenetic cancer fields claims general validity. The theoretical physicist Ulrich Behn thoroughly tested its arguments for consistency and co-authored a brief discourse of the cancer field model in a broader context at the end of this book. The authors are indebted to Professor Bahriye Aktas, Chairwoman of the Women’s Hospital at the University of Leipzig, for continuous support. M.H. is partucularly grateful to Professor Thomas Kahn, former Director of the Institute of Radiology, University of Leipzig for providing the MRI scans, to Professor Lars-Christian Horn, Institute of Pathology, University of Leipzig for producing the microphotographs of the histological sections and to Katja Schmidt for her kind long-term care of our patients. We thank the Stiftung Gynäkologische Forschung at the University Hospital of Essen for funding. The editorial and publishing efforts of Springer Nature are acknowledged.