The case against the surgical concept of en bloc dissection for certain malignancies of the reproductive tract

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Abstract
The en bloc dissection approach to many cancers of the reproductive tract needs re-evaluation in light of recent data. The mechanisms by which one or more malignant cells leaves the primary lesion and are then deposited as a viable focus at distant sites, is also in need of study. The hypothesis is put forth that metastases to regional lymph nodes occurs from the primary lesion as an embolic event leaving the intervening normal tissue bridge at low risk for disease. Indeed, these viable cells, which have the potential for becoming a metastatic focus, may fall victim to the patient's host defense mechanisms. In light of this, recent clinical experience with cancer of the cervix, vulva, and breast, is outlined with particular emphasis on more conservative surgical techniques and their success. A plea is made for individualization of surgical therapy, especially with early lesions affording ample opportunities for preservation of function, body image, and improved quality of life.