Gynecologic Oncology Surgery Research Articles

Embryological Aspects and Anatomical Variations of the Inferior Vena Cava – Its Importance in Gynecologic Oncology Surgery

Summary Surgical procedures of the retroperitoneum are often performed in gynecologic oncology surgery clinics. The most complex among them is paraaortic lymphadenectomy. It is generally performed in cases of bulky lymph nodes in ovarian carcinomas and sarcomas to achieve optimal cytoreduction. In the early stages of ovarian cancer, type II non-endometrioid endometrial cancer, and in advanced stages of cervical cancer, paraaortic lymphadenectomy is an integral part of staging. Moreover, the retroperitoneum is approached in cases of retroperitoneal gynecologic sarcomas. The largest vessels of the human body – the inferior vena cava and the abdominal aorta are localized in the retroperitoneum. Therefore, iatrogenic vessel injury during oncogynecological surgery is more likely to affect the inferior vena cava. Anatomical variations of the vein additionally increase the risk of vascular lesions. Therefore, surgeons should be aware of possible anatomical variations. The present article aimed to highlight the heterogeneity of anatomical variations of the inferior vena cava related to gynecologic oncology surgery. Embryogenesis of the vein and its variations are also discussed. Additionally, some anomalies of the ureter, associated with the embryogenesis of the inferior vena cava, are mentioned.

Preoperative anemia in gynecologic oncology surgery: Analysis of the National Surgical Quality Improvement Program Database.

e13528 Background: Preoperative anemia has been identified as risk factor for adverse postoperative outcomes following hysterectomy for benign indications. However, studies have not yet been performed looking at the effect of preoperative anemia on women undergoing surgery for a gynecologic malignancy. Methods: We used the National Surgical Quality Improvement Program data from 2014 to 2019 to conduct a retrospective, population-based cohort study. Our exposure of interest was preoperative anemia, defined as a hemoglobin value <12 g/dL and stratified using the National Cancer Institute grading system. We preformed a logistic regression was used to calculate the adjusted odds ratio evaluate the effect of anemia on the outcomes. Results: Of the 54,569 women in the cohort, 13,232 (24.2%) had anemia. Conclusions: Preoperative anemia, at any grade, is associate with an increase in postoperative morbidity and that the effect is increased with worsening grade of anemia.[Table: see text]

Relationship between race and anemia in women undergoing surgery for gynecologic cancer.

e13529 Background: Anemia is associated with poor outcomes after gynecologic surgery and there is a paucity of data whether race modify its impact on outcome. The goal of this study is to estimate the anemia prevalence in women undergoing surgery for gynecologic cancer and to evaluate the relationship between preoperative anemia and postoperative morbidity and understand whether race and ethnicity modify this relationship. Methods: We performed a retrospective cohort study of patient’s undergoing surgery for a gynecologic malignancy between 2014 and 2019 using data from the National Surgical Quality Improvement Program. Multivariable logistic regression was used to determine adjusted odds for post operative morbidity with anemia. Interaction terms were entered into the model to test for effect modification by race and ethnicity. Results: We found that Black women were twice as likely to suffer from anemia then Caucasian women. In Caucasian women 79% had normal Hgb level, 16% mild anemia, 5% moderate anemia, and 0.5% with severe anemia. However, in Black women only 59% had normal Hgb level, with 30% having mild anemia, 10% moderate anemia, and 1% with severe anemia. We also found that the adjusted odds ratio of postoperative morbidity was higher in Black women with moderate and severe anemia than in Caucasian women. (Table). Logistic regression models to predict the probability of mortality for women with varying stages of anemia. Showing a difference in probability of morbidity between Black women and Caucasian women of undergoing gynecologic oncologic surgery. Conclusions: In this cohort of 56,240 patients who had surgery for a gynecologic malignancy we found that 24% had anemia. when treated may improve postoperative outcomes were more likely to have anemia than Caucasian women in this cohort. Black women had higher rates of postoperative morbidity at all levels of anemia, demonstrating continued disparities in care. Preoperative anemia is a modifiable risk factor that when treated may improve postoperative outcomes.[Table: see text]

Effectiveness of the self-fatigue assessment in guiding early postoperative ambulation in gynaecological oncology patients: study protocol for a randomised controlled trial

IntroductionEnhanced recovery after surgery (ERAS) guidelines strongly recommends that patients be in early postoperative ambulation within 24 hours. This study aims to assess the effectiveness and safety of the self-fatigue...

Open abdomen technique used in complications of major gynecological oncology surgery

To evaluate the open abdomen technique (laparostomy) used in complications of major gynecological oncology surgery. We analyzed retrospectively the surgical database of all patients who had undergone major open surgery by the same gynecologic oncologist over a 5-year period. All patients who had had open abdomen procedure were identified; demographic data and indications of primary surgery, temporary abdominal closure procedure details, fascia closure and morbidity, mortality rates were evaluated. Intraabdominal infection and intraoperative massive hemorrhage were the major indications for all open abdomen cases. Mannheim Peritonitis Index was used perioperatively to determine open abdomen decision in intraabdominal infections. Vacuum Assisted Abdominal Closure system and Bogota Bag were used for temporary abdominal closure techniques. Out of the total 560 patients who had undergone major oncological surgery, 19 patients (3.3%) had open abdomen procedure due to surgical complications. Eleven patients had intraabdominal infection, six patients had hemodynamic instability due to peri and postoperative hemorrhage, two patients had gross fecal contamination during posterior pelvic exenteration surgery. The fascia was closed totally in 15 (78%), partially in 3 (15%) and could not be closed in 1 patient who had died secondary to multiorgan failure. Total morbidity and mortality rates were 26% (5/19) (two intrabdominal abscess, one pulmonary embolism, one skin necrosis, one enteroatmospheric fistula) and 5.2% (1/19) respectively. Open abdomen is a life-saving procedure when applied with correct indications and timing. Gynecological oncologic surgeries are candidates to serious complications and gynecologic oncologists dealing with such surgery should be as experienced as general surgeons in this regard.

Feasibility of combining pelvic reconstruction with gynecologic oncology-related surgery.

At our institution, every patient seen by the gynecologic oncology service is screened for pelvic floor dysfunction. This study was aimed at determining if a combined surgical approach by gynecologic oncology and urogynecology services at our institution was feasible and safe for this patient population. We performed a retrospective review of patients undergoing combined surgery by gynecologic oncology and urogynecology services at our institution from 2013 to 2021. Perioperative variables, postoperative adverse events, and long-term outcomes were assessed, and descriptive statistics were performed. From 20 December 2013 to 29 January 2021, a total of 102 patients underwent concurrent surgical repair of pelvic organ prolapse and/or stress urinary incontinence. Seventy-three patients (71.6%) had normal/benign pathologic conditions, and 29 (28.4%) had premalignant/malignant pathologic conditions. Ten patients (9.8%) had a postoperative complication, including reoperation for exposed midurethral sling (4.9%), urinary retention requiring midurethral sling release (2.9%), reoperation for hemoperitoneum (1.0%), and anemia requiring blood transfusion (1.0%). Nine complications occurred in patients with benign/normal pathologic conditions (12.3%), and one complication occurred in patients with pre-malignant/malignant pathologic conditions (3.4%). In our single-institution experience, concurrent gynecologic oncology and pelvic floor reconstructive surgery were safe and feasible in combination with no reported major morbidity events.

Effectiveness of enhanced recovery after surgery protocol in open gynecologic oncology surgery: A randomized controlled trial.

To examine the effectiveness of applying the recommended enhanced recovery after surgery (ERAS) protocol compared with our usual care in women with gynecologic malignancy undergoing elective laparotomy. From June 2020 to May 2021, 93 women with gynecologic cancers (cervix, endometrium, and ovary) undergoing elective laparotomy at our institution were randomly assigned into an intervention group (ERAS protocol, 46 women) or control group (usual care, 47 women). For the intervention group, each woman was brought through the pre-specified ERAS protocol starting from preoperative counseling to postoperative management. For the control group, participants underwent routine standard care. The primary outcomes were length of hospital stay and postoperative pain. The intervention group demonstrated shorter hospital stay by 20h (47.48h vs 67.17h, P= 0.02) with lower postoperative pain score at postoperative day 0 (1.58 vs 4.00, P< 0.01) and day 1 (1.00 vs 2.67, P< 0.01) while having decreased opioid consumption (P< 0.01). The intervention group also had faster recovery of gastrointestinal function. Overall, good compliance to most of the ERAS pathway domains was obtained. The ERAS protocol demonstrates benefits on shortening hospital stay, reducing pain, and bowel function recovery without increasing complications in our population. The present study was registered at clinicaltrials.gov (NCT04201626) on December 3, 2019. Initial participant enrollment began on June 1, 2020. Access through URL of the registration site: https://clinicaltrials.gov/ct2/show/NCT04201626?cond=ERAS&cntry=TH&draw=2&rank=3.

Goal-Directed Intraoperative Fluid Therapy Benefits Patients Undergoing Major Gynecologic Oncology Surgery: A Controlled Before-and-After Study.

BackgroundFluid management during major gynecologic oncology surgeries faces great challenges due to the distinctive characteristics of patients with gynecologic malignancies as well as features of the surgical procedure. Intraoperative goal-directed fluid therapy (GDFT) has been proven to be effective in reducing postoperative complications among major colorectal surgeries; however, the efficacy of GDFT has not been fully studied in gynecologic malignancy surgeries. This study aimed to discuss the influence of GDFT practice in patients undergoing major gynecologic oncology surgery.MethodsThis study was a controlled before-and-after study. From June 2015 to June 2018 in Peking Union Medical College Hospital, a total of 300 patients scheduled for elective laparotomy of gynecological malignancies were enrolled and chronologically allocated into two groups, with the earlier 150 patients in the control group and the latter 150 patients in the GDFT group. The GDFT protocol was applied by Vigileo/FloTrac monitoring of stroke volume and fluid responsiveness to guide intraoperative fluid infusion and the use of vasoactive agents. The primary outcome was postoperative complications within 30 days after surgery. The secondary outcome included length of stay and time of functional recovery.ResultsA total of 249 patients undergoing major gynecologic oncology surgery were analyzed in the study, with 129 in the control group and 120 patients in the GDFT group. Patients in the GDFT group had higher ASA classifications and more baseline comorbidities. GDFT patients received significantly less fluid infusion than the control group (15.8 vs. 17.9 ml/kg/h), while fluid loss was similar (6.9 vs. 7.1 ml/kg/h). GDFT was associated with decreased risk of postoperative complications (OR = 0.572, 95% CI 0.343 to 0.953, P = 0.032), especially surgical site infections (OR = 0.127, 95% CI 0.003 to 0.971, P = 0.037). The postoperative bowel function recovery and length of hospital stay were not significantly different between the two groups.ConclusionGoal-directed intraoperative fluid therapy is associated with fewer postoperative complications in patients undergoing major gynecologic oncology surgery.

Ten years of live surgical broadcast at Charité-MAYO conferences (2010–2019): a systematic evaluation of the surgical outcome

ObjectiveThe international Charité-MAYO Conference aims to promote international dialog on diagnostics, management, scientific breakthroughs, and state-of-the-art surgical procedures in gynecology and gynecologic oncology and senology. Live surgeries are a fundamental...

Implementation of the Policy of Enhanced Recovery after Surgery in Gynecologic Oncology

Implementation of the Policy of Enhanced Recovery after Surgery in Gynecologic Oncology

Evaluation of the Effect of Closure Technique on Incidence of Incisional Hernia after Single-Port Laparoscopy in Gynecologic Oncology Surgery

To evaluate incidence and risk factors for incisional hernia in women undergoing single-port laparoscopy (SPL) for gynecologic oncology indications with a standardized fascia closure (SC) technique vs historical controls (HC). Retrospective cohort study. Single academic institution. Women who underwent SPL from June 1, 2017, to December 31, 2019, for gynecologic oncology indications with SC were compared with HC who underwent SPL from January 1, 2009, to December 31, 2015. Data were collected for patient demographics, postoperative outcomes, and incisional hernia development. Univariate analysis and multivariable regression models were built for predictors of incisional hernia. Of 1163 patients, 242 (20.8%) patients had SC, and 921 (79.2%) patients were HC. SC cohort had lower rates of diabetes vs HC (10.3% vs 15.3%; p=.049) but no differences in hypertension (36.8% vs 43.0% p=.081) and obesity (42.6% vs 36.9%, p=.11). A total of 1123 (96.6%) patients did not undergo conversion to multiport laparoscopy or laparotomy, of whom 7.2% (n=81) of patients developed an incisional hernia; there was no difference in incisional hernia development for SC with SPL (n=237) vHC with SPL (n=886) (9.7% vs 6.5%, p=.095). On multivariable analysis, increased body mass index (odds ratio [OR] 1.06; 95% confidence interval [CI] 1.03-1.09, p < .001) and diabetes (OR 2.41; CI 1.34-4.32, p=.003) were associated with incisional hernia, but age (OR 1.00; CI .98-1.02, p=.92), length of surgery (OR 1.00; CI 1.00-1.01, p=.62), and hypertension (OR .89; CI .52-1.53, p=.68) were not. Patients with prior abdominal surgeries (OR 1.92; CI 1.14-3.26, p=.015) and hand-assist surgery (OR 3.17; CI 1.48-6.80, p=.003) were significantly associated with incisional hernia. Implementation of an SC protocol did not decrease the rate of incisional hernia vs HC during SPL. Risk of incisional hernia must be considered for SPL planning in patients with complex medical comorbidities and prior abdominal surgery.

Perioperative goal-directed fluid management using noninvasive hemodynamic monitoring in gynecologic oncology

BackgroundIntraoperative fluid management is important for the prevention of perioperative morbidity and mortality. Our study aimed to investigate the perioperative feasibility and benefits of Goal-Directed Fluid Management (GDFM) using noninvasive hemodynamic monitoring in gynecologic oncology patients with acute blood loss and severe fluid loss. We assessed the effects of GDFM on hemodynamics, organ perfusion, complications, and mortality outcomes. MethodsThis randomized prospective study included 104 patients over the age of 18 years, including 56 patients with endometrial cancer and 48 patients with ovarian cancer who had open surgery. The anesthetic approach was standardized for all patients. We compared the perioperative results of the subjects who were randomized into GDFM (n = 51) and Liberal Fluid Management (LFM) (n = 53) groups using a computer program. ResultsThe median perioperative crystalloid replacement (2000 vs. 2700; p < 0.001) and total volume of fluid (2260 vs. 3200; p < 0.001) were lower in the GDFM group compared to the LFM group. The hemodynamic findings and the HCO3 and lactate levels of the GDFM group did not significantly change perioperatively. The heart rate, mean arterial pressure, and HCO3 levels of the LFM group decreased and serum lactate levels increased perioperatively. The hospitalization rate in ICU (7.8% vs. 28.3%; p = 0.010), rate of patients with comorbidity conditions indicated in ICU (2% vs. 17%; p = 0.024), and rate of complications (17.6% vs. 35.8%; p = 0.047) were lower in the GDFM group compared to the LFM group. ConclusionThe amount of intraoperatively administered crystalloid solution and complication rates were significantly lower in gynecologic oncologic surgery patients who received GDFM. Besides, hemodynamic findings, and lactate levels of the GDFM group did not change significantly during the perioperative period.

Outcomes of Enhanced Recovery after Surgery (ERAS) in Gynecologic Oncology: A Review.

Enhanced Recovery After Surgery (ERAS) is a global surgical quality improvement program that started in colorectal surgery and has now expanded to numerous specialties, including gynecologic oncology. ERAS guidelines comprise multidisciplinary, evidence-based recommendations in the preoperative, intraoperative, and postoperative period; these interventions broadly encompass patient education, anesthetic choice, multimodal pain control, avoidance of unnecessary drains, maintenance of nutrition, and prevention of emesis. Implementation of ERAS has been shown to be associated with improved clinical outcomes (length of hospital stay, complications, readmissions) and cost. Marx and colleagues first demonstrated the feasibility of ERAS in gynecologic oncology in 2003; since then, over 30 comparative studies and 4 guidelines have been published encompassing major gynecologic surgery, cytoreductive surgery, and vulvar/vaginal surgery. Implementation of ERAS in gynecologic oncology has been demonstrated to provide improvements in length of stay, complications, cost, opioid use, and patient satisfaction. Increased compliance with ERAS guidelines has been associated with greater improvement in outcomes.

Enhanced recovery after minimally invasive gynecologic oncology surgery to improve same day discharge: a quality improvement project

ObjectivesSame day discharge after minimally invasive hysterectomy has been shown to be safe and feasible. We designed and implemented a quality improvement perioperative program based on early recovery after surgery...

Comparison of tap block and epidural block in gynecologic oncology surgeries

Comparison of tap block and epidural block in gynecologic oncology surgeries

Gynecologic oncology surgical procedures in the General hospital ”dr. Radivoj Simonovic” in Sombor in the period from 2011-2021

Introduction. In the period from 2011 - 2021, 1482 gynecologic surgeries were performed at the Department of Gynecology and Obstetrics of the General Hospital in Sombor, of which 50 (3.4%) were gynecologic oncology surgical procedures. The distribution of the malignant tumor localization was as follows: vulva 4 (8%), cervix 13 (26%), endometrium 24 (48%), and ovary 9 (18%). Material and Methods. The preoperative diagnosis of all patients included standard laboratory tests of blood and urine, chest X-ray, internal medicine specialist examination, electrocardiography, and imaging procedures (magnetic resonance imaging or computed tomography) of the small pelvis and abdomen. In all cases, the diagnosis of vulvar, cervical, and endometrial cancer was made preoperatively, based on pathohistological findings of the biopsy samples of tumor tissue or material obtained using exploratory curettage. In ovarian cancer, the diagnosis was made during surgery based on ex tempore pathohistological analysis. Results. Most of the operated patients were in the International Federation of Gynecology and Obstetrics stage I - 39 (78%) and the most common pathohistological type of tumor was adenocarcinoma of different localizations - 29 (58%). The number of lymph nodes removed per surgery was 16 - 39 (x: 19) and lymphovascular invasion was present in 31 (62%) operated patients. Intraoperative complications (bleeding, ureteral injury, infection, and wound dehiscence) occurred in 8 (16%) patients, recurrence occurred in 3 (6%), and postoperative lethal outcome occurred in 4 (8%) patients. Conclusion. The essential condition for performing gynecologic oncology surgical procedures in a secondary level healthcare facility is a well-trained gynecology surgeon who has received complete training in gynecologic oncology at the tertiary level, as well as the optimal number of gynecologic oncology surgeries in accordance with recommendations of the European Society of Gynecological Oncology.

The prevalence of undiagnosed postoperative lower limb lymphedema among gynecological oncology patients

ObjectiveLower limb lymphedema (LLL) is a common postoperative complication among gynecological oncology patients following lymph node resection. In the absence of a screening strategy, LLL is frequently diagnosed only through patient's self-reported symptoms. This study investigated the prevalence of undiagnosed postoperative LLL among gynecological oncology patients and identified the associated risk factors. Materials and methodsThis was a cross-sectional postal questionnaire survey at a tertiary gynecological oncology center. Women with gynecological malignancies who underwent lymph node (inguinal/pelvic/para-aortic) resection between 2010 and 2017 were eligible. The Gynecological Cancer Lymphedema Questionnaire (GCLQ) was used and those with a score of ≥4 were referred to a lymphedema specialist for clinical confirmation. ResultsAmong 376 eligible women, postoperative LLL was already diagnosed in 45/376 (12%) women. In the remaining women, 117/331 (35.3%) completed the GCLQ, of which 67/117 (57.3%) scored ≥4. Fifty-five women (55/67, 82.1%) were assessed by a lymphedema specialist and eight cases of postoperative LLL were confirmed. In the 12/67 who declined a clinical assessment, they reported no evidence of LLL. The prevalence of undiagnosed postoperative LLL in our study was 8/117 (6.8%, 95% C.I. 2.3–11.4). On univariate analysis, older women were more likely to have undiagnosed postoperative LLL. ConclusionsUndiagnosed postoperative LLL is not uncommon among gynecological oncology patients, especially in older patients. No vulvar cancer patient had undiagnosed LLL. Increased awareness and improved strategies for lymphedema screening are required after lymph node surgery in gynecological oncology.

Low incidence of venous thromboembolism after gynecologic oncology surgery: Who is at greatest risk?

ObjectiveTo determine the 30-day incidence of venous thromboembolism (VTE) after gynecologic oncologic surgery and identify perioperative factors associated with postoperative VTE. MethodsThe American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried to identify all gynecologic oncology cases from 2013 to 2019. Clinical and surgical characteristics, VTE events and 30-day postoperative complications were retrieved. Chi-square analysis and logistic regression models were performed to compare characteristics and postoperative outcomes of patients with and without VTE. ResultsA total of 63,198 gynecologic oncology patients were included. The incidence of 30-day postoperative VTE was 1.2% (n = 781). On multivariable analysis, postoperative VTE was significantly associated with ascites (odds ratio (OR) 1.8), disseminated cancer (OR 1.7), pre-operative albumin <30 g/L (OR 1.9), laparotomy (OR 2.8), operative time > 180 min (OR 2.0), and increased surgical complexity (OR 2.2) (all p < 0.001). The incidence of VTE was higher after laparotomy compared to minimally invasive surgery (MIS) (2.3% v. 0.6%, p < 0.001). When stratified by type of gynecologic malignancy undergoing laparotomy, incidence of VTE was higher in patients with ovarian (2.4%) and uterine (2.4%) malignancies, compared to cervical cancer (1.1%) (p < 0.001). The 30-day incidence of VTE was 1.7% in 2013 compared to 0.9% in 2019 (laparotomy: 2.6% in 2013 to 1.6% in 2019 and MIS: 0.8% in 2013 to 0.4% in 2019). ConclusionPostoperative VTE is a potentially preventable complication of gynecologic oncology surgery. Our findings indicate that laparotomy, ascites, disseminated cancer, longer operative time, and low pre-operative albumin are risk factors for VTE.

Cervical cancer treatment in Rwanda: Resource-driven adaptations, quality indicators, and patient outcomes

ObjectiveMost cervical cancer cases and deaths occur in low- and middle-income countries, yet clinical research from these contexts is significantly underrepresented. We aimed to describe the treatment quality, resource-driven adaptations, and outcomes of cervical cancer patients in Rwanda. MethodsA retrospective cohort study was conducted of all patients with newly diagnosed cervical cancer enrolled between April 2016 and June 2018. Data were abstracted from medical records and analyzed using descriptive statistics, Kaplan Meier methods, and Cox proportional hazards regression. ResultsA total of 379 patients were included; median age 54 years, 21% HIV-infected. A majority (55%) had stage III or IV disease. Thirty-four early-stage patients underwent radical hysterectomy. Of 254 patients added to a waiting list for chemoradiation, 114 ultimately received chemoradiation. Of these, 30 (26%) received upfront chemoradiation after median 126 days from diagnosis, and 83 (73%) received carboplatin/paclitaxel while waiting, with a median 56 days from diagnosis to chemotherapy and 207 days to chemoradiation. There was no survival difference between the upfront chemoradiation and prior chemotherapy subgroups. Most chemotherapy recipients (77%) reported improvement in symptoms. Three-year event-free survival was 90% with radical hysterectomy (95% CI 72–97%), 66% with chemoradiation (95% CI 55–75%), and 12% with chemotherapy only (95% CI 6–20%). ConclusionsMulti-modality treatment of cervical cancer is effective in low resource settings through coordinated care and pragmatic approaches. Our data support a role for temporizing chemotherapy if delays to chemoradiation are anticipated. Sustainable access to gynecologic oncology surgery and expanded access to radiotherapy are urgently needed.

Reconstruction of pelvic exenteration and gynecologic tumor defects: a pictorial essay for a systematic method

Background: Reconstruction of the defects created by extirpative surgery or radiation for gynecologic cancer can be challenging for both patients and surgeons. In the subset of patients who present with recurrent gynecologic cancer after previously successful treatment and radiation therapy, wounds to irradiated tissue are difficult to heal, requiring a collaborative effort between the gynecologic oncologists and the plastic and reconstructive surgeons. Other factors that may hinder successful repair include comorbidities, history of radiation, ongoing tobacco use, and overall protein malnutrition. To maximize repair success, decrease recurrence, and optimize aesthetic outcome, gynecologic oncologists and plastic and reconstructive surgeons need to communicate the anticipated anatomic and physiologic obstacles to each other and to the patient. Purpose: To create a systematic approach from our current method of gynecologic oncologic reconstruction that facilitates communication among general surgeons, gynecologic oncologists, and plastic and reconstructive surgeons to optimize gynecologic oncologic reconstructive and aesthetic outcomes while minimizing wound complications. Methods: A retrospective chart review was conducted on patients who underwent gynecologic oncologic surgery for vulvar, vaginal, cervical, and uterine cancer over a 10-year period. A step-by-step method and categorization for gynecologic reconstruction was generated from our experience, and a pictorial essay was created to demonstrate this method and highlight the most common complications. Results: The pictorial essay serves as a template for gynecologic oncology or plastic and reconstructive surgeons to follow and effectively close gynecologic tumor defects and facilitate patient care. The most common complications were seroma and distal skin necrosis, managed by early excision and closure without consequence. Satisfaction with surgical outcomes was high among the patients. Conclusion: Successful repair of primary and recurrent gynecologic tumors requires communication between the gynecologic oncologist and the plastic and reconstructive surgeon. The procedures are challenging and require resilience from both the patient and the surgeons. Incision placement is important for adequate flap reconstruction to prevent wound and skin breakdown. Wound breakdown is likely and requires preoperative counseling. High protein nutritional stores are important for expeditious healing.