Anatomy

Surgical anatomy is the synthesis of topographic and functional clinical anatomy and surgical techniques applied to diagnosis and treatment. It presents much more than a systematic description of anatomic structures, with particular emphasis on anatomical relationships. Cancer biology and tumor spread are also considered with different surgical techniques. Thus to achieve the primary goal of cancer treatment, to completely extirpate tumor masses and preserve important anatomic structures, a detailed knowledge of the anatomy of the pelvis and abdomen is essential. This skill directly influences complication rate (morbidity) and optimal debulking rate (survival) of patients with gynecologic tumors. In addition, anatomical knowledge lends insight into pathogenesis, influences treatment decisions, and is critical for effective communication between surgeons and pathologists. Studies have shown that the strongest clinician-driven predictor of survival is the optimal surgical outcome. A survey of patients with ovarian carcinoma from 904 American hospitals demonstrated that gynecologic oncologists performed more hysterectomies, oophorectomies, omentectomies, and lymph node and peritoneal biopsies and yielded higher debulking rates than other specialists. With the exception of patients with Stage I disease, patients treated by general surgeons had significantly reduced survival compared to those treated by gynecologic oncologists (p < 0.004). To optimize clinical management and to eliminate unnecessary steps and improve safety and efficacy, systematic and continual teaching in anatomy is required for all physicians who are involved in the surgical treatment of patients with gynecologic malignancies.