A trend toward more conservative surgery in gynecologic oncology

A trend toward more conservative surgical intervention is evident in the current management of many gynecologic malignancies. The trend to manage vulvar carcinoma has moved away from the standard en bloc radical vulvectomy and bilateral lymphadenectomy and now consists of more limited excision of the primary tumor as well as of the regional lymph nodes. In preinvasive cervical carcinoma, conization is preferred instead of hysterectomy. The possibility for a more conservative surgical approach is also being explored for the treatment of selected early stage and advanced or recurrent cervical carcinomas. Although the primary surgical treatment of endometrial carcinoma remains unchanged, the necessity to perform (in all cases) the more extensive procedure required for staging purposes is being challenged. In early stage borderline ovarian tumors, not only adnexectomy but cystectomy alone is considered acceptable and reexploration for staging purposes may be unwarranted. In stage IA invasive carcinoma, adnexectomy of the involved side only is probably also sufficient. In advanced ovarian carcinoma, the more aggressive cytoreduction involving multiple organ resection is being restrained. Secondary debulking is performed only on a selective basis and the routine performance of second-look laparotomy has been given up.