Type of surgeon for BRCA/high risk hysterectomy?

Posted by lilacs777 @lilacs777, Sep 4 7:50pm

Hi,
I'm a cancer survivor who needs a total hysterectomy + BSO and I'm looking for advice on if I should have the surgery done by a gyne onco surgeon rather than a regular gyne surgeon? Currently I do not have any known gyne cancer or gyne mets so its prophalytic technically, but I've heard that gyne oncos may take larger margins or do things better even for benign hysterectomies'. I also have had prior pelvic surgeries so I have scar tissue. Would love to hear advice from those that have been down this road, particularly for any that may have gone to Mayo FL, or other FL hospitals thank you.

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What type of cancer did you have.

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Hi @lilacs777, I'm a bit late to this discussion. Did you make your decision regarding which surgical specialists to go to?

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@lilacs777 Hello, I thought I would check in with you. Did you find a gyn oncology surgeon? What did you decide to do?

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i know i'm a bit late in responding but definitely find a gyn-oncology surgeon for it if you haven't already...no idea what area you're from but the surgeon at UVA who did mine was FANTASTIC...they went in and removed my ovaries, fallopian tubes, uterus, cervis, omentum, and while he was in there he found it on my appendix, meso-appendix, and also my pelvic abdominal wall that he removed nodes from that he wasn't expecting to find...he did what he called tumor debulking which was essentially removing EVERYTHING that he thought might have cancer cells on it...he removed some lesions near my rectal and bladder areas for pathology as well but both of those showed no remaining cancer cells just scar tissue from the chemo i'd been on...he DID leave 2 small areas near my colon that he said were less than a cm in size and the reason for leaving those is that would have resulted in me having a colostomy bag and the way i responded to chemo he hoped the chemo after surgery would get those...since my CA 125 is now at 12 i'm assuming it did...we'll know for sure after my next CT scan...but yes i think a gyn onc surgeon is the way to go....

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@mommacandy

i know i'm a bit late in responding but definitely find a gyn-oncology surgeon for it if you haven't already...no idea what area you're from but the surgeon at UVA who did mine was FANTASTIC...they went in and removed my ovaries, fallopian tubes, uterus, cervis, omentum, and while he was in there he found it on my appendix, meso-appendix, and also my pelvic abdominal wall that he removed nodes from that he wasn't expecting to find...he did what he called tumor debulking which was essentially removing EVERYTHING that he thought might have cancer cells on it...he removed some lesions near my rectal and bladder areas for pathology as well but both of those showed no remaining cancer cells just scar tissue from the chemo i'd been on...he DID leave 2 small areas near my colon that he said were less than a cm in size and the reason for leaving those is that would have resulted in me having a colostomy bag and the way i responded to chemo he hoped the chemo after surgery would get those...since my CA 125 is now at 12 i'm assuming it did...we'll know for sure after my next CT scan...but yes i think a gyn onc surgeon is the way to go....

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I agree. You need a gyne-oncologist. Not only are they more experienced at identifying potentially problematic tissue but they are trained to do the surgery to avoid spread of any rogue cancer cells. Nothing is perfect but a gyne-oncologist should be your first choice. Good luck going forward.

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Thank you all for your responses, sorry for the late reply, been extra busy with work lately. I'm looking at trying to find a gyne onco, possibly at the FL Mayo, since I dont know if a regular gyne could get the right margins, etc like you said. My only concern at the larger hospital systems is that they tend to rely a lot on fellows and residents to do a lot of the surgery, which really concerns me. In the past I always used surgeons that had private practice so that I could be assured it was mainly only them actually doing the surgery.

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@lilacs777. I had my hysterectomy at Mayo Clinic in Rochester. The surgical report indicated that the fellow (not a resident; a fellow has completed residency and is now in speciality or sub-speciality training such as gyn-oncology) did some of the surgery however it was under the direct supervision of my gyn-oncologist who was in the room. Personally I did not have qualms about this as I know that Mayo Clinic is a Center of Excellence and it is a teaching establishment. I think you will find that to be the case at academic comprehensive cancer care centers. You can ask a surgeon the questions about who is doing what during a surgical procedure and then decide
how you wish to proceed.

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UVA is a cancer center of excellence (and a teaching hospital) and while a small portion of it was done by a fellow the majority was done by the surgeon himself and the fellow was under the direct supervision of the surgeon himself during it.. you can always specify that you do not wish surgery to be performed by a resident or fellow....but my logic on it was its the best way for someone to learn...and my surgeon had done his fellowship at Mayo... so i was ok with it..but everyone is different...from friends i have who work in surgery as assistants etc they say the fellows and residents tend to take more time and are more cautious than the surgeons who don't have them working under them...o maybe thats why i was more confident...idk...but just my thoughts...

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