publication date: Jun. 14, 2019
When Surgical Innovation Kills
By Matthew Bin Han Ong
As they reach for surgical tools, gynecologists vastly underestimate the probability that their patients have undiagnosed uterine cancers, a study by Yale University researchers found.
 | Conversation with The Cancer Letter Vanderbilt’s Alvarez: Gynecologists must properly assess all patients for cancer before surgery I think that it probably represents a failure in our health care system. It just points out an opportunity, from a quality improvement standpoint, to make sure that everybody who is going to have a hysterectomy has the appropriate assessment for the risk of cancer preoperatively. |
 | Conversation with The Cancer Letter OU’s Mannel: Gynecologists must thoroughly evaluate postmenopausal women for hidden cancers You want to pay attention to everybody, but who are the ones that you really want to pay attention to? And I think what the study’s telling you, older women, women who are obese—you need to really pay attention to. |
 | Conversation with The Cancer Letter Fox Chase’s Rubin: Don’t morcellate and you won’t have to worry about cutting up missed cancers I think you’d have to overcome all those problems before you could say that women with fibroids ought to have a biopsy before they’re morcellated. Which, as I say, sounds like a good idea. I think the better idea is don’t morcellate the damn thing. That would solve the problem. |
 | Conversation with The Cancer Letter Yale’s Desai: Gynecologists must preoperatively workup and discuss the risks, benefits, alternatives We hope that our study increases the awareness and discussion of occult cancer risk in the thousands of women undergoing hysterectomy and myomectomy annually. Morcellation of a specimen allows for the dissemination of cancer, having an informed conversation with patients preoperatively is essential to this process. |
 | Conversation with The Cancer Letter Olive: It’s true, gynecologists don’t biopsy masses as much as other surgeons There are a lot of gynecologists who are not gynecologic oncologists who live in rural areas, who don’t have access to oncologists, or who just have big egos, who will operate on patients with known premalignant disease or early stage cancer—regardless of the fact that they know that it is cancer. |
Women who were subjected to minimally invasive surgery for early-stage cervical cancer were four times more likely to die from that disease within three years, three times more likely to have a recurrence within three years, and had shorter overall survival, compared to women who underwent open surgery, according to two groundbreaking studies published in The New England Journal of Medicine Oct. 31.
 | Conversation with The Cancer Letter Ramirez: We no longer offer minimally invasive radical hysterectomy at MD Anderson When cervical cancer patients were referred to MD Anderson Cancer Center for a prospective, phase III trial testing for noninferiority of minimally invasive vs. open abdominal radical hysterectomy, many requested the minimally invasive approach, because their referring physicians said it was better, said Pedro Ramirez, a professor of gynecologic oncology at MD Anderson. |
 | Conversation with The Cancer Letter SGO’s Kesterson: Future studies are needed to define role of minimally invasive surgery in cervical cancer Gynecologic oncologists need to reduce oncologic risk, but it’s not going to happen without knowing why minimally invasive radical hysterectomies decrease survival of patients with cervical cancer, said Joshua Kesterson, chief of the Division of Gynecologic Oncology at Penn State Cancer Institute. |
 | Experts: Minimally invasive procedures in gynecology gained universal acceptance before hard questions were asked I think these investigators should be commended in doing this trial and coming up with these results. It shows that, in a clear way, we can’t make assumptions in anything we do. The assumption that robotic surgery would be just as good as open surgery is clearly demonstrated here that it’s not a fair assumption. |
Last August, Stephen A. Chagares, a breast surgeon, made an announcement that startled some of his colleagues at New Jersey’s Monmouth Medical Center.
At internal meetings and in a press release, Chagares declared that he would perform a robotic mastectomy—a new and relatively untested minimally invasive surgical procedure. According to the press release, his first patient, Yvonne Zucco, 56, was being treated for stage IIa breast cancer.
 | Conversation with The Cancer Letter MSK’s Kirstein: Robotic mastectomy not demonstrated to be safe for treatment or prevention of breast cancer The Breast Surgical Service at Memorial Sloan Kettering Cancer Center has decided not to adopt—or study—robotic surgical devices in mastectomies, said Laurie Kirstein, a breast surgical oncologist at MSK. |
 | Conversation with The Cancer Letter MD Anderson’s Hunt and Selber: We will study immediate and long-term outcomes of robotic mastectomy in a prospective trial Robotic mastectomy deserves to be studied, because the procedure may improve cancer-related outcomes, surgeons at MD Anderson Cancer Center say. Both robotic and open procedures allow the surgeon to follow oncologic principles, said Jesse Selber, professor and director of clinical research at the Department of Plastic Surgery at MD Anderson. |
 | Penn’s Brooks: Surgeons should study oncologic endpoints for years, not just 30-day outcomes The University of Pennsylvania was planning a short-term trial for robotic mastectomies, but after an FDA advisory, investigators decided to revise that protocol to include assessment of cancer-related outcomes, said Ari Brooks, director of endocrine and oncologic surgery, director of the Integrated Breast Center at the University of Pennsylvania Health System, and professor of clinical surgery at Penn Medicine. |
Using a da Vinci robot for breast cancer surgery? Is it safe? Effective?
You might want to know that, according to informed consent documents for a study that was approved by the IRB at Monmouth Medical Center, all issues stemming from robotic mastectomy have been sorted out.
