Abstrakt
The term'out-of-the-box surgery' in gynecologic oncologywas recently coined to describe the resection of tumor growing out of the endopelvic cavity. In the specific case of pelvic sidewall involvement, a laterally extended pelvic resection may be required.
As previously defined by Hockel, this resection requires the en bloc removal of structures including the pelvic sidewall muscles, bones, nerves, and/or major vessels. This complex radical procedure leads to tumor-free margins in more than 75% of the patients, with reliable functional results.
The rate of recurrence and overall survival are directly correlated with clear resection margins. Progress in imaging, surgical techniques, and perioperative care currently offer the opportunity to attempt surgical curative resection in selected patients forwhompalliative therapy was the only alternative.
However, the procedure is associated with a high rate ofmajor postoperative complications affecting up to 60% of patients. Multidisciplinary expert centers are themost likely to achieve this complex surgerywith favorable oncological outcomes.
The aimof this review is to summarize the key issues of out-of-the-box surgery in gynecologic cancer. (C) 2022 Elsevier Inc. All rights reserved.