Book contents
- Gynaecological Oncology for the MRCOG
- Gynaecological Oncology for the MRCOG
- Copyright page
- Dedication
- Contents
- Contributors
- Preface
- Abbreviations
- 1 Epidemiology of Gynaecological Cancers
- 2 Pathology of Gynaecological Cancers
- 3 Imaging in Gynaecological Oncology
- 4 Concepts of Treatment Approaches in Gynaecological Oncology
- 5 Radiation Therapy for Gynaecological Malignancies
- 6 Systemic Therapy in Gynaecological Cancers
- 7 Preinvasive Disease, Screening and Hereditary Cancer
- 8 Surgical Principles in Gynaecological Oncology
- 9 Role of Laparoscopic Surgery
- 10 Ovarian, Fallopian Tube and Primary Peritoneal Cancer (including Borderline)
- 11 Endometrial Cancer
- 12 Cervical and Vaginal Cancer
- 13 Vulval Cancer
- 14 Uterine Sarcomas
- 15 Non-epithelial Ovarian Tumours and Gestational Trophoblastic Neoplasia
- 16 Palliative Care
- 17 Living with Cancer
- 18 Communication in Gynaecological Oncology
- Appendix
- Index
8 - Surgical Principles in Gynaecological Oncology
Published online by Cambridge University Press: 14 April 2018
- Gynaecological Oncology for the MRCOG
- Gynaecological Oncology for the MRCOG
- Copyright page
- Dedication
- Contents
- Contributors
- Preface
- Abbreviations
- 1 Epidemiology of Gynaecological Cancers
- 2 Pathology of Gynaecological Cancers
- 3 Imaging in Gynaecological Oncology
- 4 Concepts of Treatment Approaches in Gynaecological Oncology
- 5 Radiation Therapy for Gynaecological Malignancies
- 6 Systemic Therapy in Gynaecological Cancers
- 7 Preinvasive Disease, Screening and Hereditary Cancer
- 8 Surgical Principles in Gynaecological Oncology
- 9 Role of Laparoscopic Surgery
- 10 Ovarian, Fallopian Tube and Primary Peritoneal Cancer (including Borderline)
- 11 Endometrial Cancer
- 12 Cervical and Vaginal Cancer
- 13 Vulval Cancer
- 14 Uterine Sarcomas
- 15 Non-epithelial Ovarian Tumours and Gestational Trophoblastic Neoplasia
- 16 Palliative Care
- 17 Living with Cancer
- 18 Communication in Gynaecological Oncology
- Appendix
- Index
Summary
Introduction
Gynaecological oncology surgery encompasses a wide range of procedures including open ultra-radical debulking surgery, advanced laparoscopic procedures and reconstructive vulval and groin surgery. There are common underlying principles that are relevant to all surgical procedures within and outside of gynaecology, alongside principles that are more specific to gynaecological cancer operations. This chapter provides a review of surgical principles in the context of gynaecological cancer surgery. Other perioperative principles will be reviewed, including surgical complications, peri- and postoperative care, enhanced recovery (ER) and special issues relating to challenging patients.
Basics of Surgical Principles
Box 8.1 provides a comprehensive summary of basic principles that should be considered when undertaking surgery.
Preoperative, Intraoperative and Postoperative Issues
Preoperative
Preoperative assessment and optimisation are essential in gynaecological oncology patients as they are, in general, likely to be older with more complex comorbidities than the general gynaecological surgical patient. Thorough history-taking is essential to identify significant comorbidities which may have an impact on surgical planning, postoperative care and identification of potential intra- and postoperative complications.
Several preoperative investigations may be necessary to identify risks and to identify those whose clinical condition needs to be optimised prior to surgery Preoperative investigations may include
• Routine blood tests
• Full blood count – to identify anaemia, to ensure recovery of neutrophils in chemotherapy patients, etc.
• Renal function – especially in those with signs of renal obstruction
• Clotting – in those malnourished or at risk of bleeding
• Group and save – to identify those with atypical antibodies which may interfere with availability of cross-matched blood for transfusion
• LFTs – to assess preoperative albumin reflecting nutritional status in patients undergoing extensive surgery such as ultraradical surgery for advanced ovarian cancer or exenterative surgery for recurrent cancer
• Chest X-ray – especially for those at risk of pleural effusion
• HbA1c and random glucose – for those with diabetes
• Electrocardiogram
• Lung function tests
• Echocardiogram
• Pregnancy test – in all of those of child-bearing age.
A detailed discussion of the individual patient's needs and expectations preoperatively will help determine an individualised patient approach. For example, a discussion on the impact of treatment on fertility and the availability of fertility-sparing options is vital in young women. The contribution of the Clinical Nurse Specialist from the start of the process cannot be understated.
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- Gynaecological Oncology for the MRCOG , pp. 77 - 87Publisher: Cambridge University PressPrint publication year: 2018