The role of oncovascular surgery in gynecologic oncology surgery

Abstract

Oncovascular surgery is a new term used to define tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to such vessels. The benefit of oncovascular surgery has been widely described in patients with hepato-biliary-pancreatic cancers, retroperitoneal soft tissue sarcoma, and in other areas of gynecologic oncology, such as the lateral compartment of the pelvis, retroperitoneum, and hepato-biliary-pancreatic region, with an increase in complete resections and without increasing the morbidity and mortality rates. In the latter decades of the past century, several advances and accumulating scientific evidence led gynecologic oncologists to perform more thorough cytoreductive surgeries that included multivisceral resections. But to our knowledge, published studies on the frequency and relevance of vascular surgery in gynecological oncology are scarce. Gynecologic oncologists still do not receive formal training in vascular surgery and additionally, with the current reduction in experience with pelvic and para-aortic lymphadenectomy, as well as other types of radical abdominal and pelvic surgeries, trainees will encounter fewer vascular injuries and the opportunity to deal with a variety of management types required. Well-organized collaboration between each subspecialty with a multidisciplinary approach and adequate pre-operative planning are pivotal. The aim of this review is to pave the way towards the understanding that patients with suspicion of great vessels' infiltration or encasement by tumor require personalized and specialized treatment with the need to form an oncovascular surgery team, and that it is necessary for gynecologic oncology surgeons to take a step forward in surgical training.

A Planned Multidisciplinary Surgical Approach to Treat Primary Pelvic Malignancies

“…If the tumor invades the vascular bundle, it should not necessarily be considered as an obstacle to radical resection, but vascular surgeon intervention should be planned pre-operatively. [18,19,34] The decision to perform arterial or large vein preservation or resection may have oncological and morbid consequences, and therefore, a careful evaluation by the vascular surgery team is required [35,36].…”

Establishing a state‐wide pelvic exenteration multidisciplinary team meeting in South Australia

“…[5][6][7][8][9] Due to the complex nature of pelvic exenteration surgery, patients are often referred to specialized high volume centres with relevant expertise across surgical specialties, with a resulting reduction in patient mortality and surgical complication rates. 2,4,[10][11][12][13][14][15] In South Australia, pelvic exenteration surgery was historically not centralized, with appropriate reliance on interstate referrals for specialist multidisciplinary team (MDT) input. However, as patient numbers increased, it was recognized that there was a need to further clarify the management and referral pathways of these uncommon and complex patients, with the goal of improving patient outcomes.…”

“…The benefits of discussion of cases at multidisciplinary meetings are widely reported, with improved access to individualized treatment plans, higher R0 resection rates, reduced complications, reduced morbidity and improved survival 5–9 . Due to the complex nature of pelvic exenteration surgery, patients are often referred to specialized high volume centres with relevant expertise across surgical specialties, with a resulting reduction in patient mortality and surgical complication rates 2,4,10–15 …”