Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer: A Randomized Controlled Trial

Abstract

Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom > 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer centers in the Netherlands. Patients with suspected advanced-stage ovarian cancer who qualified for PCS were eligible. Participating patients were randomly assigned to either laparoscopy or PCS. Laparoscopy was used to guide selection of primary treatment: either primary surgery or neoadjuvant chemotherapy followed by interval surgery. The primary outcome was futile laparotomy, defined as a PCS with residual disease of > 1 cm. Primary analyses were performed according to the intention-to-treat principle. Results Between May 2011 and February 2015, 201 participants were included, of whom 102 were assigned to diagnostic laparoscopy and 99 to primary surgery. In the laparoscopy group, 63 (62%) of 102 patients underwent PCS versus 93 (94%) of 99 patients in the primary surgery group. Futile laparotomy occurred in 10 (10%) of 102 patients in the laparoscopy group versus 39 (39%) of 99 patients in the primary surgery group (relative risk, 0.25; 95% CI, 0.13 to 0.47; P < .001). In the laparoscopy group, three (3%) of 102 patients underwent both primary and interval surgery compared with 28 (28%) of 99 patients in the primary surgery group ( P < .001). Conclusion Diagnostic laparoscopy reduced the number of futile laparotomies in patients with suspected advanced-stage ovarian cancer. In women with a plan for PCS, these data suggest that performance of diagnostic laparoscopy first is reasonable and that if cytoreduction to < 1 cm of residual disease seems feasible, to proceed with PCS.

Fallopian tube cancer incidentally diagnosed during laparoscopy for metastatic adenocarcinoma of unknown primary lesion

“…Recent studies have proposed that laparoscopy can be utilized for identifying malignancy/benignancy in adnexal masses, or utilized as a staging and second-look procedure for ovarian cancer. 7,8 The purpose of laparoscopy in this patient was to detect unknown primary lesions of metastatic adenocarcinoma. If a primary lesion is identified, laparoscopy is converted to a suitable surgery for malignancy; otherwise, chemotherapy is immediately initiated postoperatively.…”

Role of diagnostic laparoscopy in patients with large cell neuroendocrine carcinoma of the ovary with cancerous peritonitis: case report and review of the literature

“…The role of diagnostic laparoscopy to determine the possibility of primary optimal cytoreductive surgery in patients with advanced epithelial ovarian cancer has been reported. In a randomized, controlled trial involving patients with suspected advanced ovarian cancer, diagnostic laparoscopy was reported to reduce the number of futile laparotomies and be reasonable to proceed with primary cytoreductive surgery if cytoreduction to less than 1 cm of residual disease seems feasible [39]. Moreover, the same group has reported that diagnostic laparoscopy did not increase total direct medical health care costs or adversely affect complications or quality of life [40], suggesting that laparoscopy might be a potential diagnostic procedure in advanced epithelial ovarian cancer, although port-site metastasis occurs in 16-47% of cases, and the prognostic impact is still controversial [41].…”

Impact of Laparoscopy to Assess Resectability in Stage IIIC Epithelial Ovarian, Tubal and Peritoneal Cancer Patients

“…The RT = 0 results were 87.5% for the PDS group and 59.8% for the IDS group, with a median OS of 65.3 months, compared to the IDS group's median OS of 37.8. Moreover, Rutten et al [39] recently published the results of a multicenter randomized trial in which they investigated whether diagnostic laparoscopy could prevent futile laparotomies at PDS by identifying patients with advanced-stage EOC in whom > 1 cm of residual disease would be left after PDS. They compared 102 patients assigned to laparoscopy and 99 patients who received PDS and observed a 10% rate of futile laparotomies in the laparoscopy group compared to 39% in the PDS group (RR 0.25, p < 0.001).…”