Laparoscopic Debulking Surgery in the Management of Advanced Ovarian Cancer After Neoadjuvant Chemotherapy

Corrado, Giacomo; Mancini, Emanuela; Cutillo, Giuseppe; Baiocco, Ermelinda; Vici, Patrizia; Sergi, Domenico; Patrizi, Lodovico; Saltari, Maria; Baffa, Alberto; Vizza, Enrico

doi:10.1097/igc.0000000000000491

Cited by 38 publications

(14 citation statements)

References 21 publications

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“…In the following years, reports emerged demonstrating the feasibility of the laparoscopic management of ovarian cancer, but its use has been largely limited to surgeries for diagnosis as well as the assessment of resectability and second-look procedures,25 27–29 and in the staging of select cases of early-stage disease 24 28 30–34. Some studies have also reported on laparoscopic cytoreduction in highly selected patients with advanced ovarian cancer 14–17…”

Section: Discussionmentioning

confidence: 99%

“…The use of neoadjuvant chemotherapy followed by interval surgical cytoreduction and adjuvant chemotherapy has become an option for some women with advanced ovarian cancer, offering comparable survival8–11 and decreased morbidity9–13 compared with upfront cytoreductive surgery. Preliminary studies have laid the groundwork on the feasibility of minimally invasive interval cytoreductive surgery in selected patients after neoadjuvant chemotherapy 14–20. Since the Food and Drug Administration’s approval of the da Vinci Surgical System for gynecologic procedures in 2005, it has rapidly integrated into the treatment of uterine cancer and, like laparoscopy, has resulted in reduced operative blood loss, lower incidence of post-operative complications, and faster recovery 21 22…”

Section: Introductionmentioning

confidence: 99%

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Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

Abitbol

Gotlieb

Zeng

et al. 2019

Int J Gynecol Cancer

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IntroductionWith the rapid uptake of robotic surgery in surgical oncology, its use in the treatment of epithelial ovarian cancers is being evaluated. Complete cytoreduction represents the goal of surgery either at primary cytoreduction or after neoadjuvant chemotherapy in the setting of interval cytoreduction. In selected patients, the extent of disease would enable minimally invasive surgery. The objective of this study was to evaluate the impact of introducing robotic surgery for interval cytoreduction of selected patients with stage III–IV ovarian cancer.MethodsAll patients who underwent surgery from November 2008 to 2014 (concurrent time period when robotic and open surgery were used simultaneously) after receiving neoadjuvant chemotherapy for advanced ovarian cancer (stage III–IV) were compared with all consecutive patients who underwent cytoreductive surgery by laparotomy after neoadjuvant chemotherapy between January 2006 and November 2008. Inclusion criteria included an interval cytoreductive surgery by laparotomy or robotic assistance for stage III–IV non-mucinous epithelial ovarian, fallopian tube, or primary peritoneal cancer. Exclusion criteria included patients treated concurrently for a non-gynecologic cancer, as well as secondary cytoreductive surgeries and diagnostic surgeries without an attempt at tumor reduction. Overall survival, progression-free survival, and peri-operative outcomes were compared for the entire patient cohort with those with advanced ovarian cancer who received neoadjuvant chemotherapy immediately before and after the introduction of robotic surgery.ResultsA total of 91 patients were selected to undergo interval cytoreduction either via robotic surgery (n=57) or laparotomy (n=34) after the administration of neoadjuvant chemotherapy. The median age of the cohort was 65 years (range 24–88), 78% had stage III disease, and the median follow-up time was 37 months (5.6–91.4 months). The median survival was 42.8±3.1 months in the period where both robotic surgery and laparotomy were offered compared with 37.9±9.8 months in the time period preceding when only laparotomy was performed (p=0.6). All patients selected to undergo interval robotic cytoreduction following neoadjuvant chemotherapy had a reduction of cancer antigen 125 by at least 80%, resolution of ascites, and CT findings suggesting the potential to achieve optimal interval cytoreduction. All these patients achieved optimal cytoreduction with <1 cm residual disease, including 82% with no residual disease. The median blood loss was 100 mL (mean 135 mL, range 10–1250 mL), and the median hospital stay was 1 day.ConclusionRobotic interval cytoreductive surgery is feasible in well-selected patients. Future studies should aim to define ideal patients for minimally invasive cytoreductive surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

Abitbol

Gotlieb

Zeng

et al. 2019

Int J Gynecol Cancer

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“…Another study of 91 patients selected to undergo interval CRS via robotic surgery or laparotomy showed no difference in survival between the two approaches (13). Several other small-scale, retrospective studies have drawn similar conclusions (17)(18)(19), and on a larger scale, a meta-analysis of 3,231 patients found no significant difference between minimally invasive and open interval CRS in the rate of complete cytoreduction, an important oncological outcome correlating directly with survival (20).…”

Section: Discussionmentioning

confidence: 78%

Survival and Surgical Approach among Women with Advanced Ovarian Cancer Treated with Neoadjuvant Chemotherapy

Persenaire

Pyrzak

Barber

2022

Journal of Minimally Invasive Gynecology

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“…In laparoscopic surgeries, organ injury is the main reason of conversion to open surgery. The conversion rate of laparoscopic staging surgery of EOC was reported to be 4%–10% [ 13 ], or 6.6% in laparoscopic cytoreduction [ 14 ]. In our study, the conversion rate was 3.1%.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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Laparoscopic Debulking Surgery in the Management of Advanced Ovarian Cancer After Neoadjuvant Chemotherapy

Abstract: Laparoscopic cytoreduction in patients with advanced ovarian cancer after neoadjuvant chemotherapy, when performed by skilled surgeons, seems feasible and may decrease the impact of aggressive surgery on high-morbidity patients, such as on women after chemotherapy.

Cited by 38 publications

References 21 publications

Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

Survival and Surgical Approach among Women with Advanced Ovarian Cancer Treated with Neoadjuvant Chemotherapy

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

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