Locally advanced tumors
When germination occurs, the tactics are approved by a council (often after neoadjuvant chemotherapy/radiation therapy): the goal of surgery is R0 resection, complete removal of the tumor with clean margins, even at the cost of combined resections of adjacent organs with their restoration. There is a multidisciplinary team (gynecological oncologist, surgeon, urologist); the ureters can be traced throughout. The patient is preparing extensively: nutrition, correction of anemia, prevention of thrombosis. Further treatment based on histology is mandatory.
Indications
- cervical cancer IA2–IIA — radical hysterectomy with pelvic lymph node dissection (Wertheim procedure);
- endometrial cancer - extirpation with appendages and lymph node dissection according to risk;
- ovarian cancer - cytoreductive interventions as part of complex treatment;
- vaginal cancer - radical removal with lymph node dissection;
- atypical hyperplasia with impossibility of organ preservation.
Principles of radical surgery
Oncological gynecological surgery differs from a conventional hysterectomy in volume: the tumor is removed with surrounding tissues (parameters, vaginal cuff) and lymphatic drainage pathways as a single block - this is the radicality that determines the prognosis. The number and condition of removed lymph nodes stages the disease and resolves the issue of postoperative radiation/chemotherapy. The price categories reflect the complexity: involvement of neighboring organs, the need for ureteral stenting, prevalence. The operations are performed by a gynecological oncology team with high-level anesthesiological support.
