Surgical staging of gynecologic malignancies

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.