Cancer Field Surgery in Gynecologic Oncology

This book encompasses the results of two decades of research on locoregional spread of gynecologic cancer, which put forth the ontogenetic cancer field model and its clinical translation in terms of ontogenetic tumor staging and cancer field surgery, particularly for carcinomas of the lower female genital tract. The ontogenetic cancer field model describes the propagation of malignant tumors within distinct permissive tissue regions determined by the development of the tissue from which the neoplasm originated. As the morphogenesis of multicellular animals proceeds stepwise through bifurcational cell fate specification within tissue regions dictated by the positional identity and plasticity of the precursor cell populations, tumor formation during malignant progression occurs as a stepwise process in the reverse direction with regard to positional identity and plasticity.

This principle of order can be exploited for diagnosis, treatment and prognosis of cancer in general.

The motivation to study in depth the topography of tumor spread arose from the insight that the conventional view of local cancer propagation as an unlimited isotropic process is falsified by numerous inconsistencies with clinical facts. Consequently, conventional cancer therapy based on this model cannot achieve optimal outcomes.

The cancer field model and its application in gynecologic oncology has been published in highly ranked journals. However, the complexity of the principles and practice need the format of a well-structured book for their successful transmission to gynecologic surgeons, clinical oncologists, cancer researchers and postgraduate medical students.

Michael Höckel is Professor emeritus of Gynecology at the University of Leipzig, Germany, distinguished Affiliated Professor at the Technical University of Munich (TUM), Germany as well as Director of the Leipzig School of Radical Pelvic Surgery practicing at University Hospitals in Leipzig and Essen, Germany. Prof. Höckel has established the ontogenetic cancer field model demonstrating with carcinoma of the lower female genital tract that

-  malignant tumors propagate locally within tissue domains determined by the developmental       trajectory of the tissue from which the neoplasm originated,

-  regional spread advances within lymph node regions with respect to the local cancer field and its hierarchical immunologic defense lines.

He has translated these insights clinically into ontogenetic tumor staging as well as novel cancer field surgery such as total mesometrial resection (TMMR), vulvar field resection (VFR), locally extended endopelvic resection (LEER) and their variants as well as various defense line-directed lymph node dissection techniques allowing to dispense with adjuvant radiation. These new surgeries markedly improved cure rates and decreased treatment-related morbidity in cervical, vaginal and vulvar cancer. The new conceptual approach of an order of cancer represented by the ontogenetic cancer field model can be exploited for the clinical management of malignant solid tumors in general.

Rainer Kimmig is Full Professor and Head of the Department of Gynecology and Obstetrics at the West German Cancer Center, University Hospital of Duisburg-Essen. He is master of minimally invasive, particularly robotic gynecologic surgery, former President of the “Society of European Robotic Gynaecological Surgery (SERGS)“, Vice President of the “European Society of Gynaecological Oncology (ESGO)“ and Secretary/Treasurer of the “International Gynecologic Cancer Society (IGCS)“.

His contribution to this book will address cancer field surgery of gynecologic carcinomas of the peritoneal pelvis, i.e. the endometrium, uterine tube and ovary, thus demonstrating the applicability of the cancer field model for the whole field of gynecologic oncology.

Ulrich Behn is Extraordinary Professor of Theoretical Physics at the University of Leipzig. From 2005-2016 he was Speaker of the Condensed Matter Theory Group. He conducted research in Nonequilibrium Statistical Physics on disordered and stochastic systems, noise-induced phenomena, nonlinear dynamics and pattern formation. Major themes were multifractality in random ising models; on-off intermittency in stochastically driven electrohydrodynamic convection in nematics; stochastic resonance in coupled systems; noise-induced phase transitions in spatially extended systems and since the late 1980s  mathematical modelling of the adaptive immune system: nonlinear dynamics of T-cell regulation and desensibilisation therapy of allergy; network theory of idiotypic interactions of the B-cell system, self-tolerance and autoimmunity.

Since 2017 he collaborates with Michael Höckel on physical aspects of malignant progression by reverse epigenomic state transitions.