Role of Minimally Invasive Surgery in Gynecologic Cancers

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.