“We can offer less invasive procedures to our female patients with below-the-belt cancers without compromising oncologic outcomes,” announced Amanda N. Fader, MD, Director, Kelly Gynecologic Oncology Service, and Associate Professor, Gynecology and Obstetrics, The Johns Hopkins School of Medicine. In fact, less may be more when it comes to minimally invasive surgery (MIS) for the primary treatment of certain gynecologic cancers, she added. Dr. Fader is an editorial board member for Gynecologic Oncology and serves on the NCCN Cervical/Uterine/Vulvar Cancers Panel.
Although MIS was initially used solely to aid in establishing a cancer diagnosis, it has now graduated to therapeutics, with various roles including staging, defining the extent of adjuvant therapy, and managing locoregional recurrence. In fact, laparoscopy has become the gold standard treatment of many gynecologic conditions, “both benign and malignant,” reported Dr. Fader. Many studies have shown improved outcomes with MIS,1,2 and a host of benefits have been reported, including fewer perioperative and postoperative complications, shorter hospital stays, improved cosmesis, faster recovery, and decreased costs. Furthermore, MIS may be beneficial for obese or elderly patients with many comorbidities, and less physical and psychologic trauma is another advantage.
However, admitted Dr. Fader, minimally invasive procedures have not been completely generalizable. “Despite level 1 evidence showing the benefits of laparoscopic hysterectomy and other minimally invasive procedures, there is still a 50% abdominal hysterectomy rate,” she said.
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Scalici J, Laughlin BB, Finan MA et al.. The trend towards minimally invasive surgery (MIS) for endometrial cancer: an ACS-NSQIP evaluation of surgical outcomes. Gynecol Oncol 2015;136:512–515.
Koh WJ, Greer B, Abu-Rustum NR et al.. NCCN Clinical Practice Guidelines in Oncology: Uterine Neoplasms, Version 1.2017. Accessed April 14, 2017. To view the most recent version of these guidelines, visit NCCN.org.
Palomba S, Falbo A, Mocciaro R et al.. Laparoscopic treatment for endometrial cancer: a meta-analysis of randomized controlled trials. Gynecol Oncol 2009;112:415–421.
Fader AN, Seamon LG, Escobar PF et al.. Minimally invasive surgery versus laparotomy in women with high grade endometrial cancer: a multi-site study performed at high volume cancer centers. Gynecol Oncol 2012;126:180–185.
Walker JL, Piedmonte MR, Spirtos NM et al.. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 2009;27:5331–5336.
Gala RB, Margulies R, Steinberg A et al.. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy. J Minim Invasive Gynecol 2014;21:353–361.
Beavis AL, Salazar-Marioni S, Sinno AK et al.. Sentinel lymph node detection rates using indocyanine green in women with early-stage cervical cancer. Gynecol Oncol 2016;143:302–306.