Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinosis in advanced ovarian cancer

Fagotti, Anna; Vizzielli, Giuseppe; Costantini, Barbara; Lecca, Antonella; Gallotta, Valerio; Gagliardi, Mario; Scambia, Giovanni; Fanfani, Francesco

doi:10.1111/j.1600-0412.2011.01227.x

Cited by 21 publications

(8 citation statements)

References 19 publications

(21 reference statements)

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“…Fagotti et al . [ 33 – 34 ] proposed a Predictive Index Value (PIV) based on objective parameters determined during the pre-cytoreduction laparoscopy. With this model, the likelihood that a patient would have a suboptimal surgical result (PPV) is 100% with a PIV≥8.…”

Section: Primary Cytoreductionmentioning

confidence: 99%

The role of surgery in advanced epithelial ovarian cancer

Martín-Cameán

Delgado-Sánchez

Piñera

et al. 2016

ecancer

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Nowadays, the standard management of advanced epithelial ovarian cancer is correct surgical staging and optimal tumour cytoreduction followed by platinum and taxane-based chemotherapy. Standard surgical staging consists of peritoneal washings, total hysterectomy, and bilateral salpingo-oophorectomy, inspection of all abdominal organs and the peritoneal surface, biopsies of suspicious areas or randomised biopsies if they are not present, omentectomy and para-aortic lymphadenectomy. After this complete surgical staging, the International Federation of Gynaecology and Obstetrics (FIGO) staging system for ovarian cancer is applied to determine the management and prognosis of the patient. Complete tumour cytoreduction has shown an improvement in survival. There are some criteria to predict cytoreduction outcomes based on serum biomarkers levels, preoperative imaging techniques, and laparoscopic-based scores. Optimised patient selection for primary cytoreduction would determine patients who could benefit from an optimal cytoreduction and might benefit from interval surgery. The administration of intraperitoneal chemotherapy after debulking surgery has shown an increase in progression-free survival and overall survival, especially in patients with no residual disease after surgery. It is considered that 3–17% of all epithelial ovarian carcinoma (EOC) occur in young women that have not fulfilled their reproductive desires. In these patients, fertility-sparing surgery is a worthy option in early ovarian cancer.

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Section: Primary Cytoreductionmentioning

confidence: 99%

The role of surgery in advanced epithelial ovarian cancer

Martín-Cameán

Delgado-Sánchez

Piñera

et al. 2016

ecancer

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“…In 2011, the same group of investigators [20] prospectively estimated the learning curve for determining the PIV. The authors compared the scores for each laparoscopic parameter assigned by fellows and senior surgeons.…”

Section: Laparoscopy-based Assessmentmentioning

confidence: 99%

“…In 2010, Fagotti et al [20] published results of a prospective study of laparoscopy in patients with advanced ovarian cancer prior to scheduled interval cytoreductive surgery. The aims of this study were to determine if laparoscopy could contribute to better identification of patients who would benefit from interval cytoreductive surgery and to identify the most appropriate cut-off value of PIV to identify patients unlikely to benefit.…”

Section: Laparoscopy-based Assessmentmentioning

confidence: 99%

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Predictors of optimal cytoreduction in patients with newly diagnosed advanced-stage epithelial ovarian cancer: Time to incorporate laparoscopic assessment into the standard of care

Gómez-Hidalgo

Martínez-Cannon

Nick

et al. 2015

Gynecologic Oncology

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The standard management of advanced-stage ovarian cancer has been a subject of debate, and much controversy remains as to whether patients should have primary cytoreductive surgery followed by chemotherapy or neoadjuvant chemotherapy followed by interval cytoreductive surgery. In addition, there is increasing evidence that the patients who ultimately gain the most benefit from surgery are those with no residual disease at the completion of surgery (R0 resection). Therefore, to determine the best therapeutic strategy (primary cytoreductive surgery vs. neoadjuvant chemotherapy) for an individual patient, it is critically important to estimate the likelihood that primary cytoreductive surgery will leave no macroscopic residual disease. A number of studies have evaluated the use of serologic markers, such as CA-125, and imaging modalities, such as computed tomography (CT) or positron emission tomography/CT (PET/CT), to determine which patients are ideal candidates for primary cytoreductive surgery. More recently, laparoscopy has been proposed as a reliable predictor of R0 resection. In this report, we provide a review of the existing literature on the proposed criteria to predict the outcome of cytoreductive surgery and the role of laparoscopy-based scores in the management of advanced ovarian cancer.

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“…In recent years, it has been proposed that laparoscopic procedures may also be a safe alternative to open surgery for the treatment of malignant diseases 345. However, concerns have been raised in light of numerous case reports documenting port-site recurrences after diagnostic laparoscopy or laparoscopic resection in patients with malignancies,678910 and these concerns have limited the use of laparoscopic techniques for the resection of intra-abdominal malignancies.…”

Section: Introductionmentioning

confidence: 99%

Port-Site Metastases and Chimney Effect of B-Ultrasound-Guided and Laparoscopically-Assisted Hyperthermic Intraperitoneal Perfusion Chemotherapy

Long

Zhang

et al. 2017

Yonsei Med J

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PurposeCO2 leakage along the trocar (chimney effect) has been proposed to be an important factor underlying port-site metastasis after laparoscopic surgery. This study aimed to test this hypothesis by comparing the incidence of port-site metastasis between B-ultrasound-guided and laparoscopically-assisted hyperthermic intraperitoneal perfusion chemotherapy (HIPPC).Materials and MethodsSixty-two patients with malignant ascites induced by gastrointestinal or ovarian cancer were divided into two groups to receive either B-ultrasound-guided or laparoscopically-assisted HIPPC. Clinical efficacy was assessed from the objective remission rate (ORR), the Karnofsky Performance Status (KPS) score, and overall survival. The incidence of port-site metastasis was compared between the two groups.ResultsPatients in the B-ultrasound (n=32) and laparoscopy (n=30) groups were comparable in terms of age, sex, primary disease type, volume of ascites, and free cancer cell (FCC)-positive ascites. After HIPPC, there were no significant differences between the B-ultrasound and laparoscopy groups in the KPS score change, ORR, and median survival time. The incidence of port-site metastasis after HIPPC was not significantly different between the B-ultrasound (3 of 32, 9.36%) and laparoscopy (3 of 30, 10%) groups, but significantly different among pancreatic, gastric, ovarian, and colorectal cancer (33.33, 15.79, 10.00, and 0.00%, p<0.001).ConclusionThe chimney effect may not be the key reason for port-site metastasis after laparoscopy. Other factors may play a role, including the local microenvironment at the trocar site and the delivery of viable FCCs (from the tumor or malignant ascites) to the trauma site during laparoscopic surgery.

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Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinosis in advanced ovarian cancer

Abstract: The laparoscopic assessment of peritoneal cancer diffusion according to a laparoscopic score can reliably be carried out by a fellow in gynecologic oncology after 12 months' experience without significant differences from a senior surgeon's assessment.

Cited by 21 publications

References 19 publications

The role of surgery in advanced epithelial ovarian cancer

The role of surgery in advanced epithelial ovarian cancer

Predictors of optimal cytoreduction in patients with newly diagnosed advanced-stage epithelial ovarian cancer: Time to incorporate laparoscopic assessment into the standard of care

Port-Site Metastases and Chimney Effect of B-Ultrasound-Guided and Laparoscopically-Assisted Hyperthermic Intraperitoneal Perfusion Chemotherapy

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