National Cancer Database analysis of surgical deescalation within gynecologic oncology

The goal of surgical deescalation is to minimize tissue damage, enhance patient outcomes, and reduce the adverse effects often associated with extensive or traditional surgical procedures. Analysis of the National Cancer Database investigated surgical deescalation with gynecologic oncology in the United States. In this cohort study of 1,218,490 patients with cervical, endometrial, ovarian, or vulvar cancer, several areas of surgical deescalation were identified, including an overall decrease in surgical operations, the adoption of minimally invasive techniques, and a shift toward sentinel lymph node evaluation over complete lymphadenectomy. The authors conclude that these findings suggest that as a field, gynecologic oncology is moving towards less invasive surgical methods, with may lead to potential benefits for patients but also raises concerns for surgical training and the equitable distribution of these services.