Principles of Gynecologic Oncology Surgery E-Book

Pedro T. Ramirez, Michael Frumovitz, Nadeem R. Abu-Rustum, Pedro T Ramirez, Nadeem R Abu-Rustum

• Publisher: Elsevier
• Year: 2018
• Print ISBN: 9780323428781
• eBook ISBN: 9780323442770
• Topic: Medicine
• Subtopic: Gynecology, Obstetrics & Midwifery

With an emphasis on a practical, "how-to" approach, this comprehensive text addresses the most important and commonly performed procedures in gynecologic oncology surgery today. Written by leaders in the field, Principles of Gynecologic Oncology Surgery clearly describes the critical steps for each procedure, provides up-to-date information on the recent literature, and includes high-quality illustrations of anatomy and technique.- Covers hot topics such as Enhanced Recovery After Surgery (ERAS), sentinel lymph node mapping, and minimally invasive surgery (robotic surgery, advanced laparoscopic surgery, and single site surgery).- Includes expert coverage of reconstructive surgery, colorectal surgery, urology, and vascular surgery, each written by surgeon leaders in that particular field.- Addresses the diagnosis, management and prevention of surgical complications.

Section 1

Anatomy and Principles of Surgery

Outline

Chapter 1. Introduction to Principles of Gynecologic Oncology Surgery

Chapter 2. Abdominal and Pelvic Anatomy

Chapter 3. Enhanced Recovery After Surgery in Gynecologic Oncology Surgery

Chapter 1

Introduction to Principles of Gynecologic Oncology Surgery

Pedro T. Ramirez

The modern era of gynecologic oncology surgery began in the 20th century with groundbreaking work by pioneering surgeons who explored novel surgical options for women with gynecologic malignancies. Gynecologic oncology was not approved as a subspecialty of obstetrics and gynecology until 1973, when the American Board of Medical Specialties approved it as a special qualification. Subsequently, the Society of Gynecologic Oncology (SGO) was created, and much of the credit for its foundation must be given to Hervy E. Averette and John J. Mikuta. The first scientific meeting of the SGO was held in Key Biscayne, Florida, in 1969.

Over the course of the past century, this specialty has witnessed tremendous advances in surgical technique and indications. Major innovations have been seen in imaging, cancer detection, sentinel lymph node mapping, and technology with the introduction of laparoscopy and robotic surgery. The field has shifted from very aggressive and deforming procedures to more precise and conservative approaches. Women with gynecologic cancer have options that would never even have been considered until just a few years ago. In tumors of the vulva, patients no longer undergo morbid radical tumor resection along with extensive groin lymphadenectomy. Extensive work evaluating the role of local excision combined with sentinel lymph node alone has led to the current tailored approaches offered to patients and thus a decrease in rates of perioperative complications and long-term side effects, such as debilitating lymphedema. The management of cervical cancer has evolved from the times of ultraradical surgery, such as radical hysterectomy, to modified radical surgery, fertility-preserving radical trachelectomy, or simple conization. Patients with early cervical cancer should no longer be exposed to extensive lymphadenectomy but, rather, should undergo selective and targeted sentinel lymph node mapping. For patients with locally advanced cervical cancer, the role of pretreatment selective lymph node dissection has been established as a tool to more definitively focus on the area of interest for radiation therapy. In patients with endometrial cancer, laparoscopy or robotic surgery has provided impressive outcomes, including fewer intraoperative and postoperative complications, when compared with open surgery. Sentinel lymph node mapping algorithms have also become standard of care in most centers, thus allowing patients to undergo less morbid procedures with faster recoveries. More recently, hysteroscopic resection of endometrial tumors in patients with low-risk disease has allowed young women interested in future fertility to undergo treatment that spares the uterus while at the same time treats the cancer. Even in the setting of advanced ovarian cancer, patients are more appropriately selected for up-front cytoreductive surgery or neoadjuvant chemotherapy according to the results of increasingly more accurate imaging modalities and through the direct assessment of abdominal tumor burden by means of laparoscopic surgery. Similarly, improvements in perioperative management and critical care allow surgeons to be much more aggressive when performing cytoreductive surgery or exenterative procedures in patients selected to undergo tumor debulking for advanced ovarian cancer.

Principles of Gynecologic Oncology Surgery is a broad and comprehensive textbook for all surgeons whose primary practice involves the care of women with gynecologic cancers. In each chapter, the reader learns the latest and most clinically relevant updates from the published literature on the topic of focus of that particular chapter. In addition, each chapter presents information in a format that is practical in the management of patients with gynecologic malignancies. For each disease site, the reader should appreciate standard recommendations in the initial evaluation, the preoperative workup, the step-by-step approach to the surgical procedures pertinent to that disease site, and the postoperative evaluation in the setting of complications for each of the procedures presented.

A number of chapters address topics that are all-encompassing in the field of gynecologic oncology surgery. These include chapters on Enhanced Recovery After Surgery, which is a topic of significant impact in the perioperative care of all surgical patients but one that is becoming increasingly more important in all women undergoing gynecologic surgery. In that chapter, the authors outline the current guidelines to be implemented in any Enhanced Recovery After Surgery program, with an emphasis on the importance of compliance with each of these guidelines and, ultimately, a summary of the outcomes associated with the implementation of such programs. The textbook also provides information on related and relevant surgical topics such as surgery of the intestinal and urinary tract, as well as reconstructive surgery. In each of these chapters, experts in the respective fields provide their approach in performing procedures within their area of expertise that are pertinent to gynecologic oncology surgery. Each provides tips and tricks in how to achieve the best results when performing complex procedures. Their valuable input allows gynecologic oncology surgeons to gain insight into the perspective brought by each of these specialists when consulted.

The work presented in this textbook is a composite representation of the outstanding contributions made to the field of gynecologic oncology by innumerable investigators over many years. The information presented in each chapter pays tribute to the endless hours and to the unselfish commitment that such individuals have made to improve the outcome of women with gynecologic cancers. Their innovative thinking and courage to explore beyond the status quo will continue to inspire those in all corners of the globe who continue to strive to find better strategies for prevention, diagnosis, management, and surveillance of gynecologic cancers. In this work, the amazing contribution of many patients must also be recognized. Through the history of this field, these patients have endured the impact of gynecologic cancers, and through their courage, they helped advance this field. These are patients who, in light of limited data at different times through history, accepted new diagnostic and surgical approaches, who agreed to be among the firsts by enrolling in promising surgical trials, and who gave of themselves so that others in the future could undergo better and more targeted treatment. With this textbook, tribute is paid to these patients—the true heroes who have left a lasting mark on this field.

Chapter 2

Abdominal and Pelvic Anatomy

Luis M. Chiva, and Javier Magrina

Abstract

All gynecologic oncology surgeons should be familiar with the anatomy of the abdomen and pelvis to perform all complex and radical procedures required in the surgical management of women with gynecologic tumors. Gynecologic oncologists must understand the principles of multiple surgical disciplines, such as hepatobiliary surgery, urologic surgery, colorectal and intestinal surgery, and vascular surgery. The goal of this chapter is to provide surgeons with the anatomic details of the abdomen and pelvis. The material presented here aims to describe all structures relevant to the gynecologic oncologist.

Keywords

abdominal anatomy; avascular spaces; gynecologic anatomy; gynecologic oncology surgery; pelvic anatomy; pelvic surgery; retroperitoneum; surgical anatomy; upper abdomen anatomy

An...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Contributors
• Foreword
• Preface
• Section 1. Anatomy and Principles of Surgery
• Section 2. Vulvar Cancer
• Section 3. Cervical Cancer
• Section 4. Endometrial Cancer
• Section 5. Ovarian Cancer
• Section 6. Pelvic Exenteration
• Section 7. Surgery on the Intestinal Tract
• Section 8. Surgery on the Urinary Tract
• Section 9. Pelvic Reconstructive Procedures
• Section 10. Minimally Invasive Surgery
• Index