Minimally invasive surgery in gynecological cancers: update and systematic review

Abstract

Minimally invasive surgery in gynecological cancers: update and systematic review Elisa Scarpelli1,*, Giulia Armano1 , Luciano Monfardini1 , Alissa Valenti1 , Giuseppe Barresi1 , Alessandra De Finis1 , Isabella Rotondella1 , Davide Scebba1 , Diana Butera1 1Department of medicine and surgery, University of Parma, 43125 Parma, Italy *Correspondence: elisascarpelli13@gmail.com (Elisa Scarpelli) Academic Editor: Antonio Simone Laganà Submitted: 20 December 2021 Revised: 9 January 2022 Accepted: 18 January 2022 Published: 8 April 2022 Abstract Introduction: In the last decades, the introduction of laparoscopy and, more recently, of robotic surgery, offered new options for surgical treatment also in gynecological malignancies, as an alternative to open surgery. When considering the best surgical treatment option for gynecological malignancies, evidence about safety, feasibility, and oncological outcomes must be taken into account, to offer the best treatment to the patient. The present review aims to provide an updated scenario over the available evidence in the use of minimally invasive surgery (MIS) in gynecological malignancies. Material and methods: An electronic search was performed using the following keywords: ‘minimally invasive surgery’ and ‘gynecology’, ‘minimally invasive surgery’ and ‘endometrial cancer’, ‘minimally invasive surgery’ and ‘ovarian cancer’, ‘minimally invasive surgery’ and ‘cervical cancer’. The agreement about potential relevance was reached by consensus of the researchers and according to PRISMA statement guidelines. Systematic reviews, meta-analyses, clinical trials, and original articles were included in the present review. Results: Fifty-eight studies were considered eligible for the study, 23 studies regarding MIS in endometrial cancer (EC), 19 studies on MIS in ovarian cancer (OC), and 16 studies regarding MIS in cervical cancer (CC). The total of patients enrolled was 180,057, 131,430 in the EC group, 23,774 in the OC groups, and 24,853 in the CC group. Conclusions: According to the available evidence and current clinical practice, MIS is undoubtedly the gold standard for early-stage EC treatment and may represent an acceptable option even in high-risk EC patients. Concerning OC, MIS is a safe and useful tool for staging purposes in advanced-stage disease, and a treatment option only in high volume centres with expert oncologic surgeons. On the contrary, MIS should be abandoned in the context of CC, exception made for well-selected patients, who received adequate counselling about current evidence. Keywords: Minimally invasive surgery; Endometrial cancer; Ovarian cancer; Cervical cancer