Feasibility and outcome of primary laparoscopic cytoreductive surgery for advanced epithelial ovarian cancer: a comparison to laparotomic surgery in retrospective cohorts

Abstract

ObjectivesTo assess the feasibility and outcome of primary laparoscopic cytoreductive surgery on advanced epithelial ovarian cancer in comparison with conventional open surgery.Materials and MethodsPatients undergoing primary laparoscopic cytoreductive surgery (LCS) from March 2007 to December 2016 were matched to controls treated with laparotomic cytoreduction during the same period. Procedural data and outcomes were analyzed.ResultsThe LCS group (n = 64) and laparotomic group (n = 68) had similar age, BMI, stages, histologic type and grading. The LCS group exhibited significantly less operating time (P < 0.001), less intraoperative blood loss (P < 0.001), and shorter time to recover postoperatively (P = 0.002). No statistical difference was observed for the number of pelvic and para-aortic lymph nodes dissected (P = 0.326 and P = 0.151). Significant difference was observed in satisfaction of the cytoreduction (95.3% vs. 76.5%, P = 0.008). No significant difference were observed either in intra-operative or in post-operative complications between the two groups (P = 0.250). Three patients in the LCS group experienced intra-operative complications (4.7%) and were all treated laparoscopically. The conversion rate was 3.1%. No significant differences were observed in the progression-free survival and overall survival between the two groups during the medium follow-up of 18 months (P = 0.236 and P = 0.216). The 2-year and 3-year progression-free survival was 67.9%, 55.5% in LCS group and 53.8%, 33.3% respectively in the control group. The 2-year and 3-year overall survival was 95.8%, 88.7% respectively in the LCS group and 89.0%, 83.7% in the control group.ConclusionsPrimary laparoscopic cytoreductive surgery in some strictly selected advanced stages of EOC patients was feasible and safe, resulting in oncologic outcomes not inferior to those in open surgery.

Laparoscopic Cytoreduction Combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Peritoneal Surface Malignancies (PSM): Italian PSM Oncoteam Evidence and Literature Review

“…In highly selected patients, the laparoscopic technique can lead to positive oncological outcomes even for CRS and HIPEC [32]. The postoperative recovery after mini-invasive surgery is faster, with lower pain and incidence of postoperative ileus, a quicker return to solid feeding and systemic chemotherapy, and a significant decrease in postoperative complications [35,36].…”

Ovarian cancer surgery in Germany: An analysis of the nationwide hospital file 2005–2015

“… 16 Another recent hospital-based study reported lower intraoperative complication rates and considerably lower rates of intraoperative transfusions (9.4% vs 55.9%) for laparoscopy when compared with laparotomy among patients with advanced ovarian cancer. 17 Laparoscopy has been associated in several studies with shorter length of hospital stay when compared with laparotomy. 12 – 15 , 18 – 20 Our analyses of in-hospital statistics in Germany included women with ovarian cancer at different stages and showed that ovarian surgeries performed laparoscopically were associated with considerably shorter median hospital stay (4 vs 15 days), lower risk of surgery-related complications and considerably lower risk of in-hospital mortality (0.4% vs 2.9%) in comparison to ovarian surgeries performed by open abdominal surgical approach.…”

Clinical Utility of Preoperative Assessment in Ovarian Cancer Cytoreduction

“…Multiple studies have demonstrated that minimally invasive techniques have value in evaluation, diagnosis, staging, and management of ovarian cancer [ 78 ]. To date, published studies have been retrospective analyses of small, carefully selected cohorts [ 79 , 80 ]. Both laparoscopic and robotic approaches have been utilized [ 81 ].…”