Johns Hopkins Gynecology
January 13, 2015
Merging Cutting-Edge Breakthroughs with Surgical Quality and Patient Safety
Patients who develop early-stage gynecologic cancers historically have required surgery via an open abdominal procedure. However, the introduction of minimally invasive surgery (MIS) performed through one to five tiny incisions has resulted in fewer perioperative complications, less pain and shorter hospital stays without compromising oncologic outcomes. Surgeons from the Johns Hopkins Kelly Gynecologic Oncology Service are leading the way with these techniques to bring MIS to nearly every patient with early-stage gynecologic cancer and many women with a cancer relapse.
“We believe the future of gynecologic cancer surgery lies in performing MIS in almost all patients with precancerous conditions or Stage I-II cancers, as well as incorporating cutting-edge surgical technologies into patient care with meticulous adherence to patient safety and outcomes,” says Edward Tanner, a gynecologic oncologist and director of the gynecology robotics and surgical innovations program at Johns Hopkins.
Amanda Nickles Fader, director of the Kelly Gynecologic Oncology Service, agrees. “The Society of Gynecologic Oncology and the American College of Surgeons’ Commission on Cancer consider MIS a quality measure in the management of most women with uterine cancer,” says Fader. “So it’s a top priority for our team to offer guideline-recommended care that optimizes surgical quality and safety to every woman we treat.”
Tanner directs several research studies analyzing the safety, feasibility and cancer-related outcomes associated with MIS techniques like sentinel lymph node mapping (SLN), robotic and single-site laparoscopic surgery, extraperitoneal lymphadenectomy and use of emerging diagnostic modalities. A recent technologic advance in treating uterine and cervical cancers is the use of SLN mapping with infrared fluorescence imaging to map or “light up” potentially cancerous lymph nodes during MIS procedures. For other types of cancer, such as breast malignancies, SLN mapping is performed prior to surgery using radioactive tracers and dyes. Tanner and colleagues avoid the radioactivity by using the fluorescent imaging technology instead at the time of the MIS cancer-staging procedures. Tanner has published several articles on the feasibility and safety of SLN and MIS for select cancer patients. Although further studies are ongoing at Johns Hopkins, Tanner hopes that it may become standard practice for staging procedures of the uterus and cervix, as it has for patients with other early-cancers.
Since 2012, Tanner and his Kelly Gynecologic Oncology Service colleagues have performed approximately 95% of all surgeries for early-stage cancers and precancers via the MIS approach. By increasing the number of MIS cases, the team has observed a significantly lower rate of surgical infection, complications and hospital readmissions in their patient population. However, a recent study performed by Fader and colleagues analyzed more than 30,000 uterine cancer patients from the Nationwide Inpatient Sample database treated during 2007-2011. She found that although the percentage of MIS procedures increased during the study period, more than 50 percent of early-stage uterine cancer cases were performed via large abdominal incisions, with those patients experiencing a significantly higher risk of serious complications, including life-threatening sepsis, extreme blood loss and costly hospital stays compared to patients who received MIS.
“I believe we can all do better for our patients, especially by offering innovative treatments that minimize complications and maximize the potential for outstanding surgical and cancer-related outcomes. We owe it to our patients to never lose site of how we can improve upon the care we deliver.”
To hear Edward Tanner discuss the benefits and risks of minimally invasive surgery for gynecologic cancers, visit http://bit.ly/MIS_JHGynSurgery.
For more information or to refer a patient: 410-955-8240 or 1-844-H-GYNONC (1-844-449-6662).