Minimally invasive surgery in gynecological cancers: update and systematic review

Abstract

Introduction:In the last decades, the introduction of laparoscopy and, more recently, of robotic surgery, offered new options for surgical treatment also in gynecological malignancies, as an alternative to open surgery. When considering the best surgical treatment option for gynecological malignancies, evidence about safety, feasibility, and oncological outcomes must be taken into account, to offer the best treatment to the patient. The present review aims to provide an updated scenario over the available evidence in the use of minimally invasive surgery (MIS) in gynecological malignancies. Material and methods: An electronic search was performed using the following keywords: 'minimally invasive surgery' and 'gynecology', 'minimally invasive surgery' and 'endometrial cancer', 'minimally invasive surgery' and 'ovarian cancer', 'minimally invasive surgery' and 'cervical cancer'. The agreement about potential relevance was reached by consensus of the researchers and according to PRISMA statement guidelines. Systematic reviews, meta-analyses, clinical trials, and original articles were included in the present review. Results: Fifty-eight studies were considered eligible for the study, 23 studies regarding MIS in endometrial cancer (EC), 19 studies on MIS in ovarian cancer (OC), and 16 studies regarding MIS in cervical cancer (CC). The total of patients enrolled was 180,057, 131,430 in the EC group, 23,774 in the OC groups, and 24,853 in the CC group. Conclusions: According to the available evidence and current clinical practice, MIS is undoubtedly the gold standard for early-stage EC treatment and may represent an acceptable option even in high-risk EC patients. Concerning OC, MIS is a safe and useful tool for staging purposes in advanced-stage disease, and a treatment option only in high volume centres with expert oncologic surgeons. On the contrary, MIS should be abandoned in the context of CC, exception made for well-selected patients, who received adequate counselling about current evidence.

Long-Term Outcomes of Reduced-Port Robotic Surgery (RPRS) for Uterine Myomectomy with the da Vinci Surgical System

“…These results demonstrated that RPRS can be valid surgical modality for myomectomy. There are number of research results showing that MIS and single-site robotic surgery are useful in various surgeries related to gynecological cancer [13,14]. However, in uterine myomectomy, the application of MIS is particularly difficult because firm grasp and strong pulling are required during surgery.…”

Head-to-Head Comparison: P-POSSUM and ACS-NSQIP® in Predicting Perioperative Risk in Robotic Surgery for Gynaecological Cancers

“…Over the last decade, the burden of cancer incidence as well as mortality has grown rapidly worldwide and is reflected in the rates of gynaecological cancer increase, with cervical and uterine cancer incidence and mortality being the seventh most common cancers in women [5]. With the increasing rates of GO operations, especially technically challenging minimally invasive surgery (MIS) [6,7] in obese patients and patients with multiple comorbidities, it is even more important to be able to accurately predict the likelihood of perioperative complications and involve patients in joint decision-making about their surgery. Iyer et al were able to demonstrate, in their prospective multi-centre study, that the intraoperative rate of complications amongst patients undergoing surgery for cancer was 5.4%, whereas the postoperative complications rate was 27.1% [8].…”