Rationale of Laparoscopic Surgery in Gynaecological Oncology: Time to Address the Issue!

Abstract

Laparoscopic surgery is becoming increasingly common in the management of gynaecological malignancies. However, a paucity of trained laparoscopic surgeons may lead to a compromise in its safety and quality. Through this study, we analyse the outcomes of patients with gynaecological malignancies who underwent laparoscopic surgeries elsewhere. This study is a retrospective study from October 2015 to February 2018. Thirty-eight patients with gynaecological malignancies, referred to our institute after initial laparoscopic surgeries at other centres, were evaluated for the completeness of surgery, need for adjuvant therapies and final outcome. Ovarian malignancy was found in 27 patients, fallopian tube malignancy in one, cervical carcinoma in 4 and uterine malignancy in 6 patients. The median age was 40.5 years. Most patients (68.32%) were pre-menopausal. Four surgeries were done by gynaecological oncologists. The most common presenting symptom was pain in abdomen (50%). The average size of the lesion was 9 cm (range 3–20 cm). Complete laparoscopic staging surgery was done in two cases. Omentum was evaluated in three cases. Frozen section was utilized in one case. The most common histopathology was adult granulosa cell tumour followed by serous papillary adenocarcinoma. One patient with cervical malignancy had cervical biopsy and clinical staging done. One woman with post-menopausal bleeding underwent endometrial sampling. Both underwent complete surgeries by gynaecological oncologists. Others were referred after incomplete/inadvertent surgeries. Laparoscopic surgeries for malignancies should be performed by well-trained gynaecological oncologists and be limited to high-output cancer centres.