Role of Minimally Invasive Surgery in Gynecologic Cancers

Abstract

Abstract Learning Objectives After completing this course, the reader will be able to: Describe the different minimally invasive surgical options for patients diagnosed with cervical, endometrial, or ovarian cancer.List the benefits and limitations of a minimally invasive surgical approach in patients with gynecologic cancers.Identify the clinical criteria that are useful in determining whether a patient with a gynecologic cancer is an appropriate candidate for a minimally invasive surgery. Access and take the CME test online and receive 1 AMA PRA category 1 creditTM at CME.TheOncologist.com The role of minimally invasive surgery in the management of gynecologic cancers continues to expand. Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy has emerged as a safe, reasonable option for women with early-stage cervical cancer desiring fertility preservation. Similarly, laparoscopically assisted radical vaginal hysterectomy has been systematically described, is feasible, and can be offered to women with early-stage cervical cancer who do not desire future childbearing. In the treatment of early-stage endometrial cancer, the surgical approach of laparoscopic hysterectomy, peritoneal washings, and pelvic and para-aortic lymph node dissection, with or without an omentectomy, is being compared with the same surgery performed via laparotomy in the cooperative Gynecologic Oncology Group LAP 2 study, which has completed accrual, and appears to be a reasonable surgical option. In ovarian cancer, minimally invasive surgery has been incorporated to manage early-stage, advanced-stage, and recurrent disease, as well as second-look procedures. Hand-assisted laparoscopy has also recently been described in managing larger volume primary and recurrent gynecologic cancers. Extraperitoneal laparoscopy for para-aortic and pelvic lymph node dissections has been shown to yield adequate nodal counts and to be safe and feasible in the management of gynecologic cancers.