Advances in surgery for gynecologic malignancies

Surgery has a significant role in the management of most gynecologic cancers. Recent developments in the diagnosis and management of ovarian, cervical, endometrial, and vulvar cancer are worthy of addressing in this review. Significant advances have occurred in the understanding of molecular genetic lesions, leading to a predisposition for ovarian cancer that may have a profound influence on prophylactic oophorectomy. Interval debulking surgery may provide a survival advantage for patients with advanced ovarian cancer. The loop electrosurgical excision procedure has become an integral part of the management of preinvasive disease of the cervix. Advances in the application of surgical stapling devices may lead to reduced operative time and blood loss for radical hysterectomy. Recent studies have addressed the adequacy of endometrial biopsy for the evaluation of postmenopausal bleeding. Advances in lymphatic mapping techniques have led to a novel application to the intraoperative identification of the sentinel node in vulvar cancer.