Mini-laparotomy in advanced ovarian cancer

Abstract

Optimal cytoreduction (OCR) remains the gold standard treatment of ovarian cancer. Current radiological imaging has limited sensitivity and specificity in prediction of achieving OCR prior to surgery. This prospective pilot study included 50 patients with advanced ovarian carcinoma. Prior to the main laparotomy, a mini-laparotomy-just large enough to allow a hand in-was performed. A decision was then made as to whether achieving OCR is "possible", "not possible" or lastly "unsure". Formal laparotomy then followed. At the end of the formal laparotomy, cytoreduction was regarded as either "optimal" or "suboptimal" based on residual disease. Out of 45 cases where results were deemed suitable for analysis, 27 were regarded as "OCR possible", out of which OCR was achieved in 24 cases following full laparotomy. Ten were commented upon as "unsure" and only in three cases OCR was feasible. Eight were classed as "OCR not possible" and in none of these OCR was obtained. The only noted complication associated with minilaparotomy was bleeding in just three cases (6%). The sensitivity, specificity, PPV and NPV of mini-laparotomy were 100%, 73%, 89% and 100%, respectively. However, when "unsure", only in 30% OCR was achieved. We concluded that mini-laparotomy is a safe, simple and effective technique for predicting feasibility of OCR. This simple technique could obviate the need for full laparotomy in patients who may benefit from neo-adjuvant chemotherapy.