Surgical staging of gynecologic malignancies

Abstract

The role of surgical staging in gynecologic malignancies has not been precisely defined at this time despite the conventional employment of this modality in the initial staging of ovarian neoplasms. Major discrepancies have been documented between clinical and surgical estimates of disease extent in cervical, endometrial, and vulvar carcinomas. We recently reviewed our experience with patients who were found to have positive periaortic nodes after surgical exploration for clinical Stage IB and Stage IIA cervical cancer. Postoperative extended field radiotherapy was employed with minimum complications and the 5-year actuarial survival rate was 50% with a median survival time of 29 months. In order to justify the utilization of surgical staging for gynecologic neoplasms, it is necessary to demonstrate a survival advantage in patients where the precise extent of disease has been established and subsequent therapy tailored accordingly. In addition, it must be shown that surgical staging does not increase complications or decrease the efficacy of subsequent therapeutic interventions.

Cervical Cancer: Prevention, Diagnosis, and Therapeutics

“…Studies comparing clinical with surgical‐pathologic staging (which includes status of lymph nodes) consistently have shown underestimation of disease extent by clinical staging 74 , 75 . The FIGO staging system is based on the belief that cervical cancer is primarily a local disease in the pelvis, and that a surgical staging system cannot be widely employed worldwide, especially in developing countries or in parts of developed countries where surgical staging expertise is not readily available.…”

Perioperative ultrasonography of lymph nodes in patients with gynaecological malignancy

“…In gastrointestinal malignancies, perioperative ultrasonography is important in staging to define the optimum therapeutic strategy 6,7,10 . In gynaecological malignancies, surgicopathological staging has proved to be superior to clinical staging, and precise histological staging makes it possible to choose the best therapy for each patient 11,12,17 . It is also important to remove all lymph nodes, because prognosis improves with less residual tumour remaining.…”

Extraperitoneal Laparoscopic Paraaortic Lymph Node Sampling in Prone Position: Development of a Technique

“…Dissection was started at the aorta bifurcation, using this as a landmark, and extended to the left renal artery (Figs. 2,3,4). Visualization was enhanced by using a 30-degree laparoscope.…”