Laparoscopic management of advanced epithelial ovarian cancer after neoadjuvant chemotherapy: a phase II prospective multicenter non-randomized trial (the CILOVE study)

Abstract

ObjectiveThe aim of this study was to explore the feasibility and safety of the laparoscopic approach after neoadjuvant chemotherapy among selected chemosensitive patients with advanced ovarian cancer.MethodsThe CILOVE study was a phase II prospective non-randomized multicenter study. It aimed to enroll 47 women with unresectable disease at the time of initial diagnosis (International Federation of Gynecology and Obstetrics (FIGO) stage IV and/or diffuse extensive carcinomatosis for advanced FIGO stage IIIC or patients unfit to withstand radical primary surgery), in response to chemotherapy and fit to undergo laparoscopy.ResultsAmong the 48 patients enrolled in the trial, 44 (92%) patients underwent exploratory staging laparoscopy and, as a result, 41 patients were eligible for cytoreductive surgery. Among them, 32 were intended to be managed by laparoscopy and nine patients were managed by laparotomy. The conversion rate to laparotomy was 9.4% (3/32) and the reasons were multiple surgical adhesions (n=1), miliary carcinomatosis and adhesion to the intraperitoneal mesh (n=1), and poor laparoscopic evaluation of transverse colon involvement (n=1). All except one patient had optimal cytoreduction (97% complete cytoreduction, 3% incomplete cytoreduction (residual tumor <2.5 mm)). The median operative time was 267 min (range 146–415) and the median estimated blood loss was 150 mL (range 0–500). Two patients had intra-operative complications: one diaphragm rupture that was repaired during laparoscopy and one bradycardia. Six patients experienced early post-operative complications (<1 month), but there were no grade 3 and 4 complications (3 infections, 1 lymphoedema, 2 hemorrhage). After cytoreductive laparoscopy, the percentage of patients without progression at 12 months was 87.5%.ConclusionsInterval ovarian cytoreduction by a laparoscopic approach is safe and feasible for patients with a favorable response to chemotherapy. With the widespread use of neoadjuvant chemotherapy in the management of advanced ovarian cancer, a minimally invasive approach may be a potential option.

Feasibility of laparoscopic Visceral-Peritoneal Debulking (L-VPD) in patients with stage III–IV ovarian cancer: the ULTRA-LAP trial pilot study

“…Lately the use of laparoscopy was extended to patients with advanced disease to help identify women with disease amenable to complete resection [ 31 32 ]. As previously mentioned, 2 recent studies, the CILOVE and MISSION trials [ 23 24 ], were published. From the latter a subsequent international multi-centric trial stemmed [ 33 ].…”

“…In this scenario, the ultimate attempt has been, in recent years, the use of laparoscopy to complete the whole surgical debulking [ 21 22 ]. Two trials have been published on the laparoscopic treatment of OC: the MISSION and CILOVE trials [ 23 24 ]. Both trials focused on patients who underwent neoadjuvant chemotherapy.…”

Current treatment strategies for ovarian cancer in the East Asian Gynecologic Oncology Trial Group (EAGOT)

“…A residual tumor of 0 and 0.5 cm was achieved in 29 (96.6%) patients and 1 (3.4%) patient, respectively [ 59 ]. The CILOVE study reported that all except one patient had optimal cytoreduction (97% complete cytoreduction, 3% incomplete cytoreduction) [ 60 ]. Both trials indicated that the role of laparoscopy has become more crucial in the management of ovarian cancer.…”

Updates on fluorescent probes and open‐field imaging methods for fluorescence‐guided cytoreductive surgery for epithelial ovarian cancer: A review

“…In the advanced EOC study, only selected patients had similar disease‐free and overall survival rates between the two groups; moreover, patients with widespread disease were mostly excluded from the laparoscopy group. The clinical effect of laparoscopic surgery strongly depends on the proficiency of the surgeon 31–37 . However, there is insufficient high‐quality evidence that supports laparoscopy as a substitute for laparotomy in managing EOC, regardless of the stage.…”

“…The clinical effect of laparoscopic surgery strongly depends on the proficiency of the surgeon. 31 , 32 , 33 , 34 , 35 , 36 , 37 However, there is insufficient high‐quality evidence that supports laparoscopy as a substitute for laparotomy in managing EOC, regardless of the stage. Currently, laparotomy is the routine treatment for EOC.…”