Mira Hellmann, MD, gynecologic oncologist and assistant professor, Hackensack Meridian John Theurer Cancer Center at Hackensack University Medical Center, discusses the impact of surgery on patients with ovarian cancer.

Data recently determined that secondary cytoreductive surgery in patients who received prior therapy, particularly bevacizumab (Avastin), does not improve outcomes, explains Hellmann. Additionally, research looking at PARP inhibitors found that due to the effectiveness of PARP inhibitors in 

-positive patients with ovarian cancer, the role of secondary cytoreductive therapy is negligible, says Hellmann.

The more efficacious chemotherapy or targeted therapy is, the less surgical intervention is required to patients with ovarian cancer. The use of neoadjuvant chemotherapy to determine the tumor burden followed by interval surgery versus surgical debulking upfront presented equivalent outcomes; however, patients who receive chemotherapy upfront have less aggressive surgery, mortality, and morbidity, concludes Hellmann.

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Mira Hellmann, MD, discusses the impact of surgery on patients with ovarian cancer.

Dr. Hellmann on the Impact of Systemic Therapy on Surgery in Ovarian Cancer

Mira Hellmann, MD, gynecologic oncologist and assistant professor, John Theurer Cancer Center, Hackensack University Medical Center, discusses the utility of minimally invasive surgery in cervical cancer.

In November 2018, a study was published in the 

 that demonstrated a lower rate of disease-free survival and overall survival with minimally invasive surgery versus open abdominal radical hysterectomy in women with early-stage cervical cancer.

Prior to that study, minimally invasive approaches including laparoscopic surgery and robot-assisted surgery were used frequently for patients with cervical cancer, explains Hellman.

Based on these data, abdominal radical hysterectomy and staging have become the optimal surgical approach, she concludes. 

Mira Hellmann, MD, discusses the utility of minimally invasive surgery in cervical cancer.

Dr. Hellmann on the Utility of Minimally Invasive Surgery in Cervical Cancer

Mira Hellmann, MD, gynecologic oncologist and assistant professor, John Theurer Cancer Center, Hackensack University Medical Center, discusses the use of sentinel lymph node mapping in patients with endometrial cancer.

Minimally invasive surgical approaches have taken on a greater role in endometrial cancer and vulvar cancers which have, in turn, led to improved quality of life for patients. Sentinel lymph node mapping is typically done laparoscopically or robotically. These techniques are done in lieu of a complete lymph node dissection to avoid complications such as lymphedema, pain, and increased risk of infection and bleeding, explains Hellmann.

In the FIRES trial (NCT01673022), investigators compared the sensitivity and negative predictive value of sentinel lymph node mapping versus lymphadenectomy in detecting metastatic endometrial cancer. Data showed a 99.6% negative predictive value with sentinel lymph node mapping, indicating that it can safely replace lymphadenectomy for staging, says Hellmann. However, no randomized data suggest that patients who undergo sentinel lymph node mapping have the same oncologic outcomes as those who don’t, adds Hellman.

Dr. Hellmann on Sentinel Lymph Node Mapping in Endometrial Cancer

Mira Hellmann, MD, gynecologic oncologist and assistant professor, John Theurer Cancer Center, Hackensack University Medical Center, discusses the evolution of surgical techniques in endometrial cancer.

In the past, hysterectomies and staging were done with open surgery, says Hellmann; however, this left patients with large surgical incisions. Over the past decade, surgeons have moved away from open surgeries toward the use of minimally invasive procedures, such as laparoscopies. Data from the LAP2 study, which showed an improved quality of life with laparoscopy versus laparotomy in the surgical staging of patients with endometrial cancer, helped support this shift.

The next wave of surgical advancement has led to the use of robotic surgery, says Hellmann. Robotic surgery has enabled surgeons to perform more extensive laparoscopic surgeries, as well as offer the procedure to a wider patient population, most notably, morbidly obese patients, concludes Hellmann.

Mira Hellmann, MD

Articles

Dr. Hellmann on the Impact of Systemic Therapy on Surgery in Ovarian Cancer

Dr. Hellmann on the Utility of Minimally Invasive Surgery in Cervical Cancer

Dr. Hellmann on Sentinel Lymph Node Mapping in Endometrial Cancer

Dr. Hellmann on Evolution of Surgical Techniques in Endometrial Cancer