Diagnostic Open Laparoscopy in the Management of Advanced Ovarian Cancer

Abstract

Objective. Optimal primary cytoreductive surgery (OPCS) plus adjuvant chemotherapy (AC) represents the standard management for patients with advanced ovarian cancer (AOC). Recently, some authors have suggested the use of neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) in patients with unresectable AOC. This study has been started to evaluate the role of diagnostic open laparoscopy (DOL) in predicting who are the best candidates to OPCS.Methods. All patients newly diagnosed as affected by AOC were submitted to DOL in order to establish the possibility of OPCS considered as no residual tumor left after operation. Patients considered not susceptible of OPCS were submitted to three cycles of NACT, administered every 3 weeks (Carboplatin, targeted AUC = 6, plus paclitaxel 175 mg/mq), followed by IDS and adjuvant chemotherapy.Results. From January 2000 to March 2004, 87 patients with AOC underwent DOL. Fifty-three patients (61%) were judged operable and therefore submitted to primary cytoreductive surgery (Group A). Optimal debulking rate in this group of patients was 96%. Thirty-four patients were judged affected by disease not cytoriducible to absent residual tumor and therefore scheduled for NACT-IDS-AC (Group B). Twenty-five patients were judged with partial clinical response and were therefore scheduled for IDS and AC. Optimal debulking rate (no residual tumor ) in Group B patients was 80%.No major perioperative complications, due to laparoscopy, occurred. All Group B patients received the first cycle of chemotherapy the day after DOL.In 34 patients (39%), an explorative laparotomy was avoided. With a median follow-up of 22 months (range 2 -49 months), the proportions surviving were 87% and 60% in Group A and Group B patients, respectively.Conclusion. DOL could be considered a valid diagnostic tool in evaluating the extent of disease in AOC. Our data suggest that the use of DOL leads to decrease the rate of primary cytoreductive surgery for AOC; on the other hand, a higher optimal debulking rate (no residual tumor) at primary surgery is achieved.

Mini-laparotomy in advanced ovarian cancer

“…In addition, it is associated with increased theatre time and possible increased morbidity. Furthermore, there are reported technical difficulties with the laparoscopic procedure, particularly when intra abdominal adhesions are present in advanced stage disease [23][24][25][26]. More importantly, there is a lack of tactile sensation which is of great importance in assessment of resectability and achievement of OCR [27][28][29].…”

The Safety and Efficacy of Laparoscopic Surgical Staging and Debulking of Apparent Advanced Stage Ovarian, Fallopian Tube and Primary Peritoneal Cancers

“…Additionally, no cases of unresectable disease at laparoscopy were deemed resectable at subsequent laparotomy, yielding a negative predictive value of 100%. Angioli et al 23 reported a significant improvement in rate of optimal debulking from 61% to 96% with the use of open laparoscopy to determine suitability for cytoreductive surgery. The shorter recovery period associated with laparoscopic surgery compared with recovery for laparotomy also adds the benefit of a shorter interval to commencing chemotherapy.…”

Minimally Invasive Surgical Procedures for Patients with Advanced and Recurrent Ovarian Cancer

“…In a study of 87 patients who underwent diagnostic laparoscopy, 53 were considered resectable. (25). Of these 53 patients, 96% were optimally cytoreduced.…”