Role of Video-Assisted Thoracoscopy in Advanced Ovarian Cancer: A Literature Review

Abstract

Tools that accurately predict the presence of metastatic ovarian cancer in the pleura are limited. Thus, we sought to summarize the current literature on video-assisted thoracoscopic surgery (VATS) and its applicability in patients with advanced ovarian cancer. A total of 187 patients with suspected ovarian cancer who underwent the VATS procedure were identified for this analysis. The median patient age was 59.4 years (range, 20.3-83 years). The median operative time for VATS was 32 minutes (range, 5-65 minutes). In 89 patients (48%), VATS revealed macroscopic disease in the pleural cavity. After VATS, 44 patients underwent neoadjuvant chemotherapy, and the remaining 143 patients underwent primary cytoreductive surgery. Video-assisted thoracoscopic surgery led to a change in disease stage or management in 76 patients (41%). Among patients with pleural effusions, VATS revealed pleural disease in 57% of patients, and 73% of patients with positive pleural cytology had evidence of pleural disease at the time of VATS. In addition, 23.5% of patients with negative pleural cytology had evidence of pleural disease at the time of VATS. Prospective trials are needed to accurately evaluate the impact of VATS on disease-free and overall survival in patients with advanced ovarian cancer. Video-assisted thoracoscopic surgery can help determine which patients are ideal candidates for surgical cytoreduction.

FIGO stage IV epithelial ovarian, fallopian tube and peritoneal cancer revisited

“…Furthermore, intensifying pre-operative work-up with videoassisted thoracoscopy (VATS) to detect occult pleural disease has also shown to result in a stage-shift. Guilmi et al [28] published a review regarding the role of VATS in advanced EOC and reported a shift in disease stage in 41% of the patients. In particular, pleural disease was detected in 57% of patients with pleural effusions.…”

Surgery for patients with newly diagnosed advanced ovarian cancer: which patient, when and extent?

“…Herein, VATS led to a change in stage of disease in 41% of patients. Both Escayola et al [35] and Di Guilmi et al [36] conclude that VATS may facilitate the selection of patients for PCS. Importantly, VATS should not be performed in patients with low likelihood of complete cytoreduction of tumor in abdomen and pelvis as these patients are candidates for NACT.…”

“…A review by Escayola et al [35] recently concluded that it is currently unclear whether pleural involvement can reliably be assessed by CT scan and/or chest radiograph alone, and proposed that video-assisted thoracoscopy (VATS) could be a valuable tool in describing the extent of pleural disease. One of the key findings in a review by Di Guilmi et al [36] was that among patients with negative pleural cytology, 23.5% have pleural disease determined with VATS. Herein, VATS led to a change in stage of disease in 41% of patients.…”

Thoracic anatomical landmarks and uniportal VATS cardiophrenic lymph node resection in advanced ovarian cancer

“…Its main indications are pleural assessment when a pleural effusion is present and cytoreductive surgery in resectable metastatic disease (such as cardiophrenic lymph node metastases). 1 Enlarged cardiophrenic lymph nodes are associated with a poor prognosis. Although no studies to date had shown a benefit of its removal in overall survival or progression-free survival, as we show, it is a feasible technique.…”