LAUSR

Oncovascular surgery is a new term used to define tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to them. Its paradigm is that the tumor mass that invades the vascular system should not necessarily be considered an obstacle to radical resection, which often involves enbloc resection of the tumor with infiltrated vessels. This approach involves preoperative planning within a multidisciplinary team. The benefit of oncovascular surgery has been widely described in patients with hepatobiliarypancreatic cancers, with an increase in complete resections and without increasing the morbidity and mortality rate. Similar results have been obtained in retroperitoneal soft tissue sarcoma and in other areas of gynecologic oncology such as the lateral compartment of the pelvis, retroperitoneum, and hepatobiliarypancreatic region. But who should lead oncovascular surgery in a gynecologic oncology procedure? This topic may be complex and will vary from institution to institution, likely depending on wellorganized collaborations between each subspecialty. Woo et al reviewed the role of the vascular surgeon in various settings in a tertiary hospital and found that 490 (87%) requests were for intraoperative care. Among the most common reasons were lymph node dissection (42.4%), vascular invasion (26.1%), vascular exposure (15.5%), and bleeding (11.8%), with 109 (22.2%) of these as emergency calls. Lymphadenectomy was the most common reason (52.5%) for consultation in planned surgery, while bleeding (40.4%) was the most common reason for unplanned surgery, which led to a higher rate of morbidity and reaffirms the need to form an oncovascular surgery team. Surgical gynecologic oncology has grown over the past four decades and advanced ovarian cancer is its paradigm. Training is the cornerstone for the development of oncovascular surgery, and gaining experience as well as surgical skills in complex procedures requires a continuous process that may be accomplished through lectures, dry lab, wet lab, and dissection of cadavers. In conclusion, the concept of ‘oncovascular surgery’ is considered a fundamental part of the curative treatment of advanced cancers with possible vascular involvement. Wellorganized collaboration between each subspecialty with a multidisciplinary approach and adequate preoperative planning are pivotal. The lack of studies on the frequency and relevance of vascular surgery in gynecologic oncology, as well as the scarcity of information on the vascular approach in this area, should encourage us as gynecologic oncologists to take a step forward on this endeavor.