Surgical limits in gynecologic oncology

Abstract

Surgical treatment plays a key role in the therapeutic management of patients diagnosed with malignancy. In 2017, standards for the diagnosis and surgical treatment of gynecologic cancers were developed and published by the Polish Gynecological Oncology Society. Preoperative consultation with other specialists is needed in patients with comorbidities. A multidisciplinary surgical approach is necessary in many cases. In 2017, Denis Querleu presented criteria limiting the implementation of optimal surgery in the “International Journal of Gynecological Cancer.” In the case of disseminated cancer, where there is no possibility to perform radical procedure, ultra-radical (extensive) surgeries should be avoided as they are associated with high complication rates. Neoadjuvant systemic therapy seems more beneficial. The paper attempts to answer the question on when to take the risk of surgery. Based on all necessary additional investigations, a surgeon is able to assess whether there are conditions for optimal cytoreduction. Once consent is obtained from a patient motivated to undergo aggressive treatment, proper preoperative management is necessary – parenteral nutrition to obtain adequate levels of serum proteins, preparation of the gastrointestinal tract, frequent ureteral splinting for better ureteral identification as well as patient consent for colostomy and blood product transfusion. The paper includes general guidelines for the qualification for surgical treatment of gynecologic cancer.