Surgery for malignant gynecologic disease.

The surgical management of malignant gynecologic disease continues to evolve as more is learned about the natural history and biology of these neoplasms. Whereas curing malignancies remains the ultimate goal of most surgical procedures for gynecologic cancers, the importance of quality of life cannot be ignored. Surgical procedures that enhance the quality of life without compromising cure continue to be explored. In vulvar cancer, the disfiguring classical radical vulvectomy is being replaced by more conservative procedures. As anesthetic techniques and postoperative care continue to improve, the role of radical surgery for invasive and recurrent cervical cancer has been extended to include older women. Ovarian cancer continues to be the most lethal of all gynecologic malignancies, and the role of aggressive primary and secondary cytoreduction continues to be defined. The new International Federation of Gynecology and Obstetrics staging system for endometrial cancer has generated controversy regarding the benefits and morbidity associated with surgical staging.