Moffitt Cancer Center's treatment teams include surgeons who specialize in minimally invasive surgeries (MIS) utilizing robotic surgical systems for a variety of cancer types, including gynecologic cancers.
Many patients report a higher quality of life during MIS recovery due to a shorter hospital stay and less postoperative pain, but it's vital that cancer surgeons understand when MIS procedures are optimal for their patients and when they are not.
Gynecologic Cancers That Benefit Most From MIS
Certain gynecologic cancers benefit equally—or even more—from minimally invasive surgery as compared to open surgery.
Endometrial cancer is ideal and has become the standard for MIS because it overcomes many of the challenges of open surgery on patients with a greater body mass while minimizing the risk of metastatic spread. In these cases, MIS is equivalent to open surgery, requires a shorter hospital stay, and allows for the easiest patient recovery.
MIS is also effective in identifying whether there is a presence of cancer, and it's common for medical teams to begin the diagnostic process with MIS.
Gynecologic Cancers Not Prone to MIS
On the other hand, ovarian and cervical cancers may not be the best fit for MIS.
Despite a rising trend of using MIS in ovarian cancers, Moffitt's Department of Gynecologic Oncology Chair Dr. Robert Wenham recommends against its widespread use in ovarian cancer. Though recovery is easier on the patient, MIS may not allow for full removal of all visible cancer, which is critical to increasing patient lifespan.
"I have done thousands of MIS and open cases, and I know that it is impossible to use MIS and see some of the areas that cancer can hide. I, too, want my patients to have the smallest scars, the shortest hospital stays, and shortest recoveries – but not at the expense of worse cancer survival outcomes," said Dr. Wenham.
As for cervical cancer, Dr. Wenham believes MIS should be avoided until more data can explain why studies show worse outcomes as compared to open surgery. The two studies he refers to showed a negative effect on the survival of women who underwent MIS for cervical cancer, which confirmed his suspicion that there’s less control over margins.
- A 2018 randomized controlled study demonstrated that the number of disease recurrences after MIS was nearly 4x higher and death from any cause was 6x higher than after open surgery
- A second study reported a 50% higher relative risk of dying within four years of MIS compared to open surgery
Dr. Wenham no longer performs cervical cancer MIS and will continue using the surgical approach with the best-reported data to support a cure. It’s also worthwhile to note that surgical considerations for any specific patient may impact the risk-benefit ratio for MIS vs. open surgery, and there’s no one-size-fits-all approach.
"Data on the risks of minimally-invasive cervical cancer surgery shouldn’t dissuade patients from opting for its use for a variety of other cancers or diseases."- Robert Wenham, MD
Moffitt Cancer Center's Gynecological Clinic
Moffitt's gynecological cancer survival rates often exceed national averages, and our ambitious research has contributed to our status as a National Cancer Institute-designated Comprehensive Cancer Center, the only one based in Florida.
As a referring physician, you can trust our gynecologic oncologists to provide your patients with comprehensive cancer care, including, when appropriate, MIS procedures that leverage advanced techniques to preserve organ health, maintain sexual function and achieve the best quality of life.
To refer a patient to Moffitt, complete our online form or contact a physician liaison for assistance or support. As part of our efforts to shorten referral times as much as possible, online referrals are typically responded to within 24 - 48 hours.