Surgery Options for Gynecologic Cancers

November 12, 2015 Brigham and Women's Hospital

Colleen M. Feltmate, MD, Director of Minimally Invasive Surgery in Gynecologic Oncology at Brigham and Women’s Hospital, and Michael G. Muto, MD, gynecologic oncologist, performed the first robotic radical hysterectomy in New England in September of 2006.

Drs. Colleen Feltmate and Michael Muto performed the first robotic radical hysterectomy in New England.

For many women with gynecologic cancers, surgery is often the first line of defense. Colleen Feltmate, MD, Director of Minimally Invasive Surgery in Gynecologic Oncology at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC), explains surgical options to treat these gynecologic cancers.

Minimally Invasive vs. Open Surgeries

Minimally invasive surgery, or laparoscopy, is increasingly used to treat gynecologic cancers, often with the assistance of a robot. Robotic surgery can give surgeons improved control and precision during intricate procedures, and requires only a few small incisions, as opposed to larger, open surgeries.

Minimally invasive procedures, with or without robotic assistance, can reduce hospital and recovery time, and often cause less pain post-surgery. Dr. Feltmate and colleagues in the  DF/BWCC Susan F. Smith Center for Women’s Cancers recently published a study in the Annals of Surgical Oncology showing that patients who underwent laparoscopic hysterectomies and were discharged the same day did not experience increased post-operative complications. Patients who have open surgeries using a larger incision generally stay three to four days in the hospital and have a recovery period of up to six weeks.

For endometrial (uterine) cancer, the most common gynecologic cancer, the vast majority of patients are eligible for minimally invasive surgery to remove the uterus, cervix, fallopian tubes, and/or ovaries through a small incision. But this approach may not be right for all gynecologic cancer patients.

“There are a number of medical or anatomical reasons why minimally invasive surgery may not be used,” notes Dr. Feltmate. These include the uterus being too large to remove in one piece; previous abdominal or pelvic surgery; past chemotherapy or radiation treatment; or intolerance to carbon dioxide, which is used to expand the abdomen during laparoscopic procedures. Open surgery also may be required, depending on the cancer and its stage. Women with ovarian cancer in particular are more likely to be treated with open surgery, as they are often diagnosed in later stages when the cancer has spread.

Sentinel Node Biopsies

“The goal of gynecologic surgeries is always to take out less,” says Dr. Feltmate. One way surgeons do this is through sentinel node biopsies, which use dyes to locate and remove lymph nodes where the cancer has spread to prevent unnecessary node removal and additional surgeries. This strategy is often used in vulvar cancer and increasingly in endometrial and cervical cancers.

Sentinel node biopsies also help prevent lower leg swelling, which can happen when lymph nodes are removed during gynecologic surgery, Dr. Feltmate says.

 Preventive Surgeries

With increased attention on the connection between mutated genes and cancer, there has been an influx in prophylactic (preventive) gynecologic surgeries, says Feltmate. Women like actress Angelina Jolie who test positive for the BRCA-1 or BRCA-2 genes may decide to undergo a preventive salpingo-oophorectomy to remove the ovaries and fallopian tubes. These genes increase a woman’s lifetime risk of ovarian cancer to 20-40 percent, a jump from the two percent risk among the general population. Another familial condition, Lynch syndrome, which causes polyps or pre-cancers to develop in the colon or uterus earlier than in the general population, puts women at an increased risk of endometrial and ovarian cancers, and some may elect to have a preventive hysterectomy. Speaking with a genetic counselor can help women understand the risks and benefits of preventive surgery.

This post originally appeared on Insight, the blog of Dana-Farber Cancer Institute.

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