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Chapter-29 Laparoscopic staging of pelvic malignancies

BOOK TITLE: Minimally Invasive Gynecologic Surgery: Evidence-Based Laparoscopic, Hysteroscopic and Robotic Procedures

Author
1. Diver Elisabeth
2. Boruta II David
ISBN
9781909836099
DOI
10.5005/jp/books/12892_30
Edition
1/e
Publishing Year
2016
Pages
8
Author Affiliations
1. Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
2. Harvard Medical School; Massachusetts General Hospital, Boston, Massachusetts, USA
Chapter keywords
surgical staging, orogastric drainage, dorsal lithotomy, inappropriate treatment, gynecologic oncology, atraumatic graspers, omentectomy, paracolic gutters, ultrasonic shears, laparoscopic bags, proctoscopy, lymphadenectomy, malignant tumors, endometrial cancer, retroperitoneum, radical hysterectomy

Abstract

This chapter discusses laparoscopic staging of pelvic malignancies, where staging of gynecologic malignancies is a cornerstone of oncologic management. Accurate information regarding the absence or presence of metastatic disease, and its location, provides useful prognostic information and allows adjuvant treatment such as chemotherapy or radiation, to be prescribed appropriately. The testing modalities approved for clinical staging include examination under anesthesia, cystoscopy, proctoscopy, and imaging and laboratory studies. Large, potentially malignant tumors, including an enlarged uterus with an underlying endometrial cancer, may not easily be removed via a natural orifice such as the vagina, let alone small port-site incisions. Immediate postoperative outcomes, including reduced blood loss, infectious morbidity, and hospital stay are improved with apparent equivalent progression-free and overall survival Robotic-assisted laparoscopy is increasingly used to aid in the performance of laparoscopic surgical staging of endometrial cancer. Laparoscopic surgery is commonly employed for cervical cancer, both for radical hysterectomy and for lymphadenectomy.

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