Advances in Gynaecological Cancer Care: A Robotic Surgery Milestone, RPLND for Recurrent Cancers & Fertility After Cancer
Quick answer: Gynaecological cancer care today goes far beyond chemotherapy and radiation. At Narayana Health, Mazumdar Shaw Medical Centre, Bengaluru, our Gynaecology-Oncology team recently completed 24 successful robotic gynaec-onco surgeries in a single month, performed retroperitoneal lymph node dissection (RPLND) in 27 cases of recurrent gynaecological cancer over five years, and helped a young endometrial cancer survivor become a mother through fertility preservation. This blog explains what each of these advances means for patients and families.
1. A Milestone in Robotic Gynaec-Onco Surgery: 24 Surgeries in One Month
Robotic surgery has transformed how we treat gynaecological cancers such as endometrial (uterine), cervical and selected ovarian cancers. Through a few small incisions, the surgeon operates with robotic instruments that offer a magnified, stable 3D view and precise movement around delicate structures.
For patients, this typically translates into:
- Smaller incisions and less blood loss
- Less post-operative pain
- Shorter hospital stay and faster return to daily life
- Precise removal of cancer tissue and lymph nodes
Celebrating excellence in care and innovation: Narayana Health recently recognised Dr. Rohit R. Ranade and team for a remarkable milestone – 24 successful robotic gynaec-onco surgeries completed in just one month. Beyond the number, this reflects a mature robotic programme: consistent case selection, a trained surgical team, and safe, reproducible outcomes for women with gynaecological cancers.
2. Beyond Chemoradiation: RPLND in Recurrent Gynaecological Cancers
What is RPLND? Retroperitoneal Lymph Node Dissection (RPLND) is a surgery that removes cancer-involved lymph nodes situated at the back of the abdomen, close to major blood vessels — the aorta, inferior vena cava and renal vessels.
Recurrence after primary cancer treatment poses a difficult therapeutic problem. Systemic chemotherapy and immunotherapy remain the standard for most recurrences. However, when the recurrence is isolated to retroperitoneal lymph nodes in a patient with good performance status, a window for surgery opens — particularly when the disease has proven resistant to chemotherapy and radiation.
Our five-year experience at Mazumdar Shaw Medical Centre
Over the past five years at Mazumdar Shaw Medical Centre, Narayana Hrudayalaya, we have performed RPLND in 27 cases of recurrent gynaecological cancer:
- 14 recurrent ovarian cancers
- 6 recurrent endometrial cancers
- 6 recurrent cervical cancers
- 1 recurrent vulval cancer
All patients had nodal recurrence confirmed on PET-CT and CT-guided biopsy, and had received varying combinations of prior surgery, chemotherapy and radiation. Nodal dissection was carried up to the level of the renal vessels where required, with the aim of complete clearance.
Why teamwork matters in RPLND
Metastatic nodes often lie against major vascular structures. Planned involvement of the vascular surgery team allowed safe dissection planes and complete nodal clearance without vascular compromise. The anaesthesia team was equally central — providing close haemodynamic monitoring, preparedness for major intra-operative blood loss, and perioperative support through these long procedures in a previously irradiated, hostile operative field.
Outcome: Post-operative recovery was uneventful across the series, with all patients discharged in stable condition. RPLND for isolated retroperitoneal recurrence is a viable and potentially curative option in well-selected patients — including those with para-aortic nodal disease resistant to chemotherapy and radiation.
Looking ahead: the robotic platform is expected to play a larger role in these dissections. Its magnified, stable view of the retroperitoneum and precise instrumentation around the great vessels allow even more thorough nodal clearance in this difficult surgical field.
3. Cancer and Fertility: End of Hope or a New Beginning?
The word "cancer" often evokes fear and the feeling that life has come to a halt — especially for young women planning a family. A few decades ago, that perception was not entirely untrue. Today, with remarkable advances in oncology, reproductive medicine and assisted reproductive technologies, cancer is no longer the end of life — or motherhood.
A real patient journey from our Gyn-Oncology practice
A newly married woman in her early 30s, actively trying to conceive, was incidentally diagnosed with endometrial cancer — a malignancy of the innermost lining of the uterus. Due to the type and extent of disease, preserving the uterus was unfortunately not a safe option, and she required surgery with removal of the uterus as part of her cancer treatment.
However, thanks to advances in fertility preservation, her eggs were successfully retrieved and cryopreserved before treatment. Today, she is a cancer-free survivor and, with the help of surrogacy, has been blessed with a child.
The message: a diagnosis of cancer does not necessarily mean the end of reproductive potential or parenthood. With timely diagnosis, multidisciplinary care and evolving reproductive technologies, many women can still realise their dream of becoming mothers — even after cancer. Cancer may change the path, but it does not always end the destination.
Frequently Asked Questions (FAQs)
What is robotic gynaec-onco surgery?
Robotic gynaec-onco surgery is a minimally invasive technique where the surgeon operates through small incisions using robotic arms that give a magnified 3D view and precise, tremor-free movements. It is used for gynaecological cancers such as endometrial, cervical and selected ovarian cancers, and generally offers less blood loss, less pain and faster recovery than open surgery.
What is retroperitoneal lymph node dissection (RPLND)?
RPLND is a surgery that removes cancer-involved lymph nodes at the back of the abdomen, near major vessels such as the aorta, inferior vena cava and renal vessels. In recurrent gynaecological cancers, isolated nodal recurrence in a fit patient can be treated with RPLND for locoregional control, and it can offer a survival benefit in carefully selected patients.
Can recurrent gynaecological cancer be treated with surgery instead of only chemotherapy?
Yes, in selected cases. Chemotherapy and immunotherapy remain standard for most recurrences, but when recurrence is isolated to retroperitoneal lymph nodes and the patient is otherwise fit, surgery such as RPLND becomes a viable and potentially curative option — especially when the disease has resisted chemotherapy and radiation.
Is RPLND safe if I have already had radiation?
A previously irradiated field makes the surgery technically more difficult, but with a coordinated team — gynaecological oncology, vascular surgery and anaesthesia working together — complete and safe resection is achievable. In our 27-case series, post-operative recovery was uneventful and all patients were discharged in stable condition.
Can a woman have a baby after cancer treatment?
Yes, in many cases. With fertility preservation techniques such as egg retrieval and cryopreservation before treatment, many women can still become mothers after cancer — through their own pregnancy where safe, or through options such as surrogacy. Discuss fertility preservation with your oncologist at the time of diagnosis, before treatment begins.
When should fertility preservation be discussed?
Ideally at the time of cancer diagnosis, before any surgery, chemotherapy or radiation. These treatments can affect the ovaries and uterus, so early planning with a gynaecological oncologist and fertility team gives the best chance of preserving reproductive potential.
How do I know if I am a candidate for robotic surgery or RPLND?
Candidacy depends on the type and stage of cancer, the site of recurrence, prior treatments, imaging findings such as PET-CT, and your overall fitness. A consultation with a gynaecological oncologist is the right first step to evaluate your individual case.
Where can I consult Dr. Rohit R. Ranade in Bengaluru?
Dr. Rohit Raghunath Ranade consults at Narayana Health, Mazumdar Shaw Medical Centre, Bommasandra, Bengaluru. You can call 8951971380 or visit the contact page to book an appointment.
Written & Medically Reviewed by Dr. Rohit R. Ranade
Senior Consultant, Clinical Lead – Gynaecology-Oncology,
Robotic Surgery, Laparoscopic Gynaec Surgery, HIPEC
Specialist
MBBS, MS (Gynaecology), MCh (Gynecological Oncology)
Program Director – Fellowship in Gynaec Oncology, Narayana
Health, Mazumdar Shaw Medical Centre, Bengaluru
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