Maximum volume
The combination of an advanced tumor and urinary tract involvement requires the entire arsenal: stents (sometimes with resection and reimplantation of the ureter), resection of the bladder/colon with reconstruction, wide lymph node dissection to the lumbar level. Such operations are performed after consultation, often in combination with chemotherapy/radiation therapy before or after. Recovery is gradual: catheter and stents according to timing, monitoring of kidney function, rehabilitation. The goal justifies the complexity - complete removal of the tumor provides a chance for long-term remission even with local spread.
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.
