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Laparoscopy for primary cytoreduction with multivisceral resections in advanced ovarian cancer: prospective validation. “The times they are a-changin”?

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Abstract

Background

Primary cytoreduction is the mainstay of treatment for advanced ovarian cancer (AOC). We developed and prospectively evaluated an algorithm to investigate the possible role of laparoscopic primary cytoreduction (LPC) in carefully selected patients, with AOC.

Methods

From June 2007 to July 2015, all patients with stage III–IV ovarian cancer and clinical conditions allowing aggressive surgery were candidate to primary cytoreduction with the aim of achieving residual tumor (RT) = 0. The possibility of attempting laparoscopic cytoreduction was carefully evaluated using strict selection criteria. The other patients were approached by abdominal primary cytoreduction (APC). At the end of LPC, an ultra-low pubic mini-laparotomy was performed to extract surgical specimens and to accomplish a laparoscopic hand-assisted exploration of the abdominal organs, in order to confirm complete excision of the disease.

Results

Of the included 66 patients, 21 were considered eligible for LPC; the remaining 45 underwent APC. Optimal cytoreduction (i.e., RT = 0) was obtained in 95 and 88.4% in the LPC and APC groups, respectively. No intra-operative complication and 4 (19%) early post-operative complications were observed among patients who received LPC. Patients who underwent APC had 17.8 and 46.7% intra- and early post-operative complications, respectively. Median time to initiation of chemotherapy was 15 (range, 10–30) days in the LPC group and 28 (20–35) days in the APC group. After a median follow-up of 51 months, 2-year disease-free survival was 76.2% in the LPC group and 73.4% in the APC group.

Conclusions

After strict selection, a group of patients with AOC may undergo LPC with extremely high rates of optimal cytoreduction, satisfactory perioperative morbidity, a short interval to chemotherapy, and encouraging survival outcomes.

Clinical trial registration NCT02980185

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacro Cuore “Don Calabria” Hospital, Negrar, Verona, Italy

    Marcello Ceccaroni, Giovanni Roviglione, Francesco Bruni & Roberto Clarizia

  2. Department of General Surgery, International School of Surgical Anatomy, Sacro Cuore “Don Calabria” Hospital, Negrar, Verona, Italy

    Giacomo Ruffo

  3. Department of Nuclear Medicine, Sacro Cuore “Don Calabria” Hospital, Negrar, Verona, Italy

    Matteo Salgarello

  4. Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy

    Michele Peiretti

  5. Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi, 1, 21100, Varese, Italy

    Stefano Uccella

Authors
  1. Marcello Ceccaroni
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  2. Giovanni Roviglione
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  3. Francesco Bruni
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  4. Roberto Clarizia
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Correspondence to Stefano Uccella.

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Marcello Ceccaroni, Giovanni Roviglione, Francesco Bruni, Roberto Clarizia, Giacomo Ruffo, Matteo Salgarello, Michele Peiretti, and Stefano Uccella have no conflict of interest or financial ties to disclose.

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Ceccaroni, M., Roviglione, G., Bruni, F. et al. Laparoscopy for primary cytoreduction with multivisceral resections in advanced ovarian cancer: prospective validation. “The times they are a-changin”?. Surg Endosc 32, 2026–2037 (2018). https://doi.org/10.1007/s00464-017-5899-9

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