Should laparoscopy be included in the work-up of advanced ovarian cancer patients attempting interval debulking surgery?

Fagotti, Anna; Fanfani, Francesco; Vizzielli, Giuseppe; Gallotta, Valerio; Ercoli, Alfredo; Paglia, Amelia; Costantini, Barbara; Vigliotta, M.; Scambia, Giovanni

doi:10.1016/j.ygyno.2009.09.015

Cited by 61 publications

(29 citation statements)

References 24 publications

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“…When selecting candidates for primary cytoreductive surgery, it is important to identify those in whom laparotomy might be expected to suffice and those in whom laparotomy is likely to result in suboptimal cytoreduction and needless delay of chemotherapy. Diagnostic laparoscopy recently was introduced as a method for assessing the resectability of advanced-stage ovarian cancer with the intention of either proceeding directly to primary cytoreductive surgery or, in the presence of lesions deemed nonresectable, deferring surgery in favor of neoadjuvant chemotherapy (46)(47)(48). However, some anatomic sites are "blind spots" that are inaccessible at laparoscopy, and it is important that the radiologist report any evidence of The falciform ligament directly communicates with the periportal space, which is often involved in disseminated carcinomatosis.…”

Section: Disease That Is Inaccessible With a Laparoscopic Approachmentioning

confidence: 99%

Ovarian Carcinomatosis: How the Radiologist Can Help Plan the Surgical Approach

Nougaret¹,

Addley²,

Colombo³

et al. 2012

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Ovarian carcinoma is the most common cause of death due to gynecologic malignancy. Peritoneal involvement is present in approximately 70% of patients at the time of initial diagnosis. The disease spreads abdominally by direct extension, exfoliation of tumor cells into the peritoneal space, and dissemination of tumor cells along lymphatic pathways. Carcinomatosis characterizes an advanced stage of disease in which peritoneal disease has spread throughout the upper abdomen (stage IIIC) or in which diffuse peritoneal disease is accompanied by malignant pleural infiltration or visceral metastases (stage IV). Common sites of intraperitoneal seeding of ovarian carcinoma include the pelvis, omentum, paracolic gutters, liver capsule, and diaphragm. Soft-tissue thickening, nodularity, and enhancement are all signs of peritoneal involvement. Advanced-stage disease is treated either with initial cytoreductive surgery (debulking) followed by adjuvant chemotherapy, or with initial neoadjuvant chemotherapy followed by debulking. Radiologic imaging plays an important role in the selection of patients who may benefit from neoadjuvant chemotherapy before debulking. However, accurate interpretation of the imaging findings is challenging and requires a detailed knowledge of the complex peritoneal anatomy, directionality of flow of peritoneal fluid, and specific disease sites that are likely to present particular difficulties with regard to surgical access and technique. Although there is as yet no clear consensus on the criteria for resectability of peritoneal lesions, extensive involvement of the small bowel or mesenteric root, involved lymph nodes superior to the celiac axis, pleural infiltration, pelvic sidewall invasion, bladder trigone involvement, and hepatic parenchymal metastases or implants near the right hepatic vein are considered indicative of potential nonresectability. Implants larger than 2 cm in diameter in the diaphragm, lesser sac, porta hepatis, intersegmental fissure, gallbladder fossa, or gastrosplenic or gastrohepatic ligament also may represent nonresectable disease.

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Section: Disease That Is Inaccessible With a Laparoscopic Approachmentioning

confidence: 99%

Ovarian Carcinomatosis: How the Radiologist Can Help Plan the Surgical Approach

Nougaret¹,

Addley²,

Colombo³

et al. 2012

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116

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“…In the last decade, some institutions have matched the laparoscopic exploration in order to assess resectability in advanced disease [24, [41][42][43]. Advantages of laparoscopy include magnification of pelvic and abdominal anatomy and enhanced visualization of the peritoneum surface of the upper abdomen, particularly diaphragm.…”

Section: Laparoscopic Explorationmentioning

confidence: 99%

How to improve the optimal cytoreductive surgery in advanced ovarian carcinoma

2011

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Advanced ovarian carcinoma is a lethal tumour, and its standard treatment is consists of aggressive primary cytoreductive surgery followed by a chemoadjuvance based on platinum agents. We searched the Cochrane Gynaecological Cancer Group Trials Register of 2010, Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE of 2010. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies. One of the goals of its management is to achieve the longest overall survival possible, and the most important survival factor is the residual tumour after cytoreductive surgery, obtaining the best surveillance in the cases where no tumour is left in the abdomen. To improve the cytoreductive rates in the actual management strategy, a change is necessary, selecting the cases not suitable for primary debulking surgery and adding, if necessary, procedures different than the ovarian tumour resection, like bowel resections, peritonectomies (particularly diaphragmatic ones) and splenectomies. This review pretends to understand why advanced ovarian carcinoma should be treated with primary surgery whenever possible and to rationate the use of extrapelvic surgical procedures. The improvement of surgical rates with these manoeuvres can determine the best management of our patients, without clinical complications.

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“…Based on a complex statistical analysis (9), the positive appraisal of each variable has been settled as equal to 2, thus leading to a final PIV of between 0 and 14. We demonstrated that the percentage of cases correctly identified as suboptimally resectable (sensitivity) rose with the PIV cut‐off level, and the possibility of a suboptimal surgical result (positive predictive value=PPV) increased up to 100% in with a PIV >8 (9–12). Although the performance of the laparoscopic model has been validated prospectively in a large series of advanced ovarian cancer patients treated by the same surgical team who developed the model, some questions still remain regarding reproducibility, i.e.…”

Section: Introductionmentioning

confidence: 95%

“…In previous studies, we elaborated a laparoscopy‐based score system to predict the chances of complete cytoreduction in advanced ovarian cancer patients (9–12). This system, named predictive index value (PIV), is obtained by summing single scores linked to the presence/absence of some specific cancer features assessed by laparoscopy, such as omental cake, peritoneal and diaphragmatic carcinomatosis, mesenteric retraction, bowel and stomach infiltration, and superficial liver metastases.…”

Section: Introductionmentioning

confidence: 99%