Robotic surgery in ovarian cancer

Gallotta, Valerio; Certelli, Camilla; Oliva, Riccardo; Rosati, A.; Federico, Alex; Loverro, Matteo; Lodoli, Claudio; Foschi, Nazario; Lathouras, Konstantinos; Fagotti, Anna; Scambia, Giovanni

doi:10.1016/j.bpobgyn.2023.102391

Cited by 7 publications

(3 citation statements)

References 82 publications

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“…Although current guidelines still recommend laparotomy for early-stage ovarian cancer, a significant proportion of early-stage ovarian cancer is discovered incidentally during minimally invasive surgery for benign conditions of pelvic cavity. The greatest advantage of minimally invasive surgery is that it reduces intraoperative and postoperative complications and shortens the length of stay in hospital while has a similar surgery scope and effect to open surgery (37)(38)(39), which is consistent with our original intention to determine the optimal number of ELNs, that is, to remove as many lymph nodes with occult metastasis as possible while minimizing the surgical trauma by controlling the number of ELNs. Lymphadenectomy in the process of minimally invasive surgery may have the following characteristics: First, the local magnification of lymph nodes by laparoscopic and robotic surgical equipment allows the surgeon to obtain a clearer view of the surgical field during lymphadenectomy; Secondly, median numbers of ELNs in minimally invasive surgery and laparotomy were similar, and there was no significant reduction (40)(41)(42)(43).…”

Section: Discussionsupporting

confidence: 66%

“…Third, minimally invasive surgery is easier to perform sentinel lymph node biopsy than open surgery. Given that a large number of retrospective studies and meta-analyses suggested that the oncologic outcome in patients with minimally invasive surgery was no worse than that in patients undergoing open surgery (a reliable conclusion even with prolonged follow-up) (37,39,(41)(42)(43)(44), we believe that lymphadenectomy by minimally invasive surgery may be beneficial for early-stage ovarian cancer.…”

Section: Discussionmentioning

confidence: 88%

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Speculation on optimal numbers of examined lymph node for early-stage epithelial ovarian cancer from the perspective of stage migration

Li,

Ding,

Zheng

et al. 2023

Front. Oncol.

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IntroductionIn early-stage epithelial ovarian cancer (EOC), how to perform lymphadenectomy to avoid stage migration and achieve reliable targeted excision has not been explored in depth. This study comprehensively considered the stage migration and survival to determine appropriate numbers of examined lymph node (ELN) for early-stage EOC and high-grade serous ovarian cancer (HGSOC).MethodsFrom the Surveillance, Epidemiology, and End Results database, we obtained 10372 EOC cases with stage T1M0 and ELN ≥ 2, including 2849 HGSOC cases. Generalized linear models with multivariable adjustment were used to analyze associations between ELN numbers and lymph node stage migration, survival and positive lymph node (PLN). LOESS regression characterized dynamic trends of above associations followed by Chow test to determine structural breakpoints of ELN numbers. Survival curves were plotted using Kaplan-Meier method.ResultsMore ELNs were associated with more node-positive diseases, more PLNs and better prognosis. ELN structural breakpoints were different in subgroups of early-stage EOC, which for node stage migration or PLN were more than those for improving outcomes. The meaning of ELN structural breakpoint varied with its location and the morphology of LOESS curve. To avoid stage migration, the optimal ELN for early-stage EOC was 29 and the minimal ELN for HGSOC was 24. For better survival, appropriate ELN number were 13 and 8 respectively. More ELNs explained better prognosis only at a certain range.DiscussionNeither too many nor too few numbers of ELN were ideal for early-stage EOC and HGSOC. Excision with appropriate numbers of lymph node draining the affected ovary may be more reasonable than traditional sentinel lymph node resection and systematic lymphadenectomy.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 88%

Speculation on optimal numbers of examined lymph node for early-stage epithelial ovarian cancer from the perspective of stage migration

Li,

Ding,

Zheng

et al. 2023

Front. Oncol.

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“…Even robotic surgery plays a role in selected cases of ROC undergoing SCS, providing its advantages in terms of 360 • movements, tremor filtering, stable 3D vision, and an ergonomic position of the surgeon [58].…”

Section: The Minimally-invasive Approachmentioning

confidence: 99%

Minimally-Invasive Secondary Cytoreduction in Recurrent Ovarian Cancer

Certelli,

Russo,

Palmieri

et al. 2023

Cancers

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The role of secondary cytoreductive surgery (SCS) in the treatment of recurrent ovarian cancer (ROC) has been widely increased in recent years, especially in trying to improve the quality of life of these patients by utilising a minimally-invasive (MI) approach. However, surgery in previously-treated patients may be challenging, and patient selection and surgical planning are crucial. Unfortunately, at the moment, validated criteria to select patients for MI-SCS are not reported, and no predictors of its feasibility are currently available, probably due to the vast heterogeneity of recurrence patterns. The aim of this narrative review is to describe the role of secondary cytoreductive surgery and, in particular, minimally-invasive procedures, in ROC, analyzing patient selection, outcomes, criticisms, and future perspectives.

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