Surgical Management for Recurrent Gynecologic Malignancy

Park, Sang Yoon

Abstract

Surgery continues to be an important option in the management of recurrent gynecologic malignancies. As a single modality, it can be the sole curative treatment for a selected group of patients with localized recurrent malignancy and contributes to the management of patients with more disseminated recurrent malignancy as part of multimodal treatment. The use of exenterative surgery for localized recurrence has been extended, and complications have been minimized. Our understanding of the role of cytoreduction in disseminated recurrence has increased, but care must be taken in order to maximize the benefit of cytoreduction and minimize morbidity until the evidences are more clarified in prospective randomized trial. Morbidity related to radical surgery can be reduced without compromising patient cure by individualizing surgery. Moreover, newer reconstructive techniques can improve quality of life. Sometimes, surgery can be performed with relatively simple procedures, such as wide local excision. However, for more disseminated cancers, such as metastatic ovarian cancer, surgery can be very complex, requiring resection of several non-gynecological organs. Therefore extensive surgical training and experience is needed to successfully manage patients with these challenging conditions, and this has resulted in the development of the subspecialty of gynecological oncology. A brief update on the role of surgery in the management of recurrent gynecologic malignancies is presented in this article.