Learning objectives
To review the current surgical treatments for advanced gynecologic cancers and accompanying anatomical changes
To discuss post-treatment cross-sectional imaging findings important to radiologists
Background
Gynecologic tumors are often located in the narrow pelvis, which is densely packed with blood vessels, lymphatic vessels, nerves, and ureters; therefore, surgical or other interventional complications are often unavoidable. As some complications can be fatal without intervention, clinicians need to be familiar with their pathogenesis. Recent advances in gynecologic treatment, such as total parietal peritonectomy (described here as a new treatment), have improved survival outcomes. With the expanded indications for these highly retroperitoneally invasive treatments, newly experienced complications have become more common. Familiarity with...
Findings and procedure details
A. Review of Gynecologic Cancer-Related Surgical Treatment and Anatomical Changes
1. Treatment of advanced gynecologic cancer (Fig.2,3)
The basic gynecological surgeries are hysterectomy with bilateral salpingo-oophorectomy (BSO), lymph node dissection, and cytoreductive surgery for ovarian cancer/primary peritoneal cancer/fallopian tube cancer.
Hysterectomy: Total hysterectomy (TH) is standard procedure, and radical hysterectomy (RH) is usually performed for endometrial carcinoma extending to the uterine cervix and advanced cervical cancer. Radical hysterectomy includes pelvic lymph node dissection (PLN).
Bilateral salpingo-oophorectomy (BSO): In most gynecologic cancer treatments, the ovaries are...
Conclusion
Diagnostic radiology plays a major role in the management of post-treatment gynecologic cancer, and familiarity with it can contribute to clinical practice.
Personal information and conflict of interest
S. Oda:
Nothing to disclose
H. Kuno:
Nothing to disclose
T. Hiyama:
Nothing to disclose
T. Kobayashi:
Nothing to disclose
References
Harter P, Sehouli J, Lorusso D, et al.: A Randomized Trial of Lymphadenectomy in Patients with Advanced Ovarian Neoplasms. New England Journal of Medicine 380:822–832 2019.
Sugarbaker P H: Peritonectomy procedures. Annals of Surgery 221:29–42 1995.
Baratti D, Kusamura S, Cabras A D & Deraco M: Cytoreductive Surgery with Selective Versus Complete Parietal Peritonectomy Followed by Hyperthermic Intraperitoneal Chemotherapy in Patients with Diffuse Malignant Peritoneal Mesothelioma: A Controlled Study. Annals of Surgical Oncology 19:1416–1424 2012.
Muallem M Z, Sehouli J, Miranda A, Richter R &...