Moffitt Onco Update

Scarless Gynecologic Oncology Surgery

January 04, 2016

Scarless-Gynecologic-Oncology-Surgery.jpg Minimally invasive surgery can make cancer less disruptive to patient quality of life

Applications of Single Incision Laparoscopic Surgery

Mian M. Shahzad, MD, PhD 

Today, women affected by most gynecologic malignancies can benefit from minimally invasive surgical advances, currently used for the majority of non-cancerous gynecological surgeries. Single incision laparoscopy (SIL) is a novel, minimally invasive approach in which the entire surgery is performed through a single incision that is usually hidden inside the umbilicus. Rather than operating through a large abdominal incision or the 3 to 5 small incisions used for traditional laparoscopy, SIL surgery is performed via a single 2 to 3 cm incision with a multi-channel laparoscopic port. All surgical instruments are placed through this small incision at the base of the belly button. With incision through the umbilicus, patients benefit from tiny virtually “scarless” results with favorable clinical and outstanding aesthetic outcomes. 

Single incision laparoscopic surgery requires both optimal surgical expertise and optimal instrumentation. Moffitt is one of only a handful of hospitals in the state of Florida offering SIL procedures for women with early-stage gynecologic cancers as well as some benign diagnoses. This approach along with conventional laparoscopic or robotic surgery is performed  at the Moffitt Cancer Center for a majority of gynecologic malignancies or complex benign disease:

  • Bilateral salpingo-oophorectomy for therapeutic or risk reductive purposes
  • Treatment of cervical cancer and fertility sparing surgery
  • Pelvic masses (8-10 cm) that appear to be benign
  • Endometrial cancer staging and treatment
  • Enlarged uteri or uterine fibroids
  • Simple or radical hysterectomy
  • Pelvic and para-aortic lymph node dissection
  • Surgical staging for gynecologic malignancies 

In the future, the single-port techniques may expand to ovarian cancer staging, ovarian cystectomy and removal of larger benign pelvic masses.

Moffitt's Gynecologic Oncology Program

Our gynecologic oncology team provides a comprehensive array of some of the most innovative minimally invasive surgical treatments, including robotic surgery. For women who are candidates, SIL and other minimally invasive surgery can make cancer less disruptive and help maintain a high postoperative quality of life with faster recovery. 

As a category, minimally invasive techniques cause less postoperative pain, earlier return to normal activities, fewer postoperative complications (such as wound infection, damage to surrounding organs, or hernia), minimal blood loss and, in some cases, shortened operative times compared with open techniques. Open procedures require a 3 to 4 night hospital stay, versus minimally invasive gyn-onc procedures where the patient is up and eating the same day and goes home the next day.

Referring to an academic cancer center like Moffitt that has an excellent gynecologic oncology team available can help patients avoid multiple surgeries or delays in adjuvant treatment, and ensure proper staging. Additionally, supportive care resources, which include a psychiatrist, palliative care and pain management specialists, and social workers among others. Supportive care resources are all readily available at Moffitt and play an important role from the onset of treatment, as needed. We recommend the following patients be considered for a referral to our gynecologic oncology team:

  • Post menopausal women with complex pelvic mass +/- elevated CA125
  • Women with severe cervical dysplasia or cervical cancer
  • Uterine cancer patients or patients with atypical endometrial hyperplasia
  • Those with a vulvar/vaginal cancer diagnosis
  • Women with cervical cancer

Where Cancer Patients are Treated First Matters Most

Data now indicate that patients who receive care by a trained gynecologic oncologist  have improved overall survival.1 Additionally, outcomes of cancer treatment are better when provided by a gynecologic oncologist and in specialized hospitals;2 for example, at Moffitt Cancer Center. Moffitt is the only National Cancer Institute (NCI) designated cancer center based in Florida and ranked #1 in cancer care in the state of Florida.

About Dr. Mian Shahzad

Dr. Shahzad is among a handful of gynecologic oncology surgeons in Florida who are trained in single incision laparoscopy. Dr. Shahzad completed his Gynecologic Oncology fellowship at the University of Wisconsin Carbone Cancer Center, where he became adept in minimally invasive techniques including single-port surgery, multi-port robotic-assisted laparoscopic procedures, as well as open techniques. Dr. Shahzad has worked at the University of Texas M.D. Anderson Cancer Center, Houston as a women’s reproductive health research scholar and taught at the Baylor College of Medicine. His philosophy is to educate each patient and then allow her to be empowered in her course of care. Dr. Shahzad discusses all surgical options available with patients to enable them to collaboratively make the best individual decision about what approach to take, and thoroughly reviews risks, recovery and outcomes. Dr. Shahzad communicates closely with referring physician(s) and coordinates treatment recommendations, especially for patients who live a distance from Moffitt or who are already receiving chemotherapy with their local oncologist. Dr. Shahzad has more than 30 articles published and multiple grants related to gynecologic cancers. His research interests include the effects of stress and depression on cancer growth and metastasis as well novel therapeutic approaches. 

References

1. Chan JK, et al. Influence of Gynecologic Oncologists on the Survival of Patients With Endometrial Cancer. J Clin Oncol. March 2011;29(7):832-838.

2. Vernooij F. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: A systematic review. Gynecol Oncol. June 2007;105(3):801-812.