Laparoscopy for diagnosing resectability of disease in women with advanced ovarian cancer

Vrie, Roelien van de; Rutten, M.J.; Asseler, Joyce D.; Leeflang, Mariska; Kenter, Gemma G.; Mol, Ben W.; Buist, Marrije R.

doi:10.1002/14651858.cd009786.pub3

Cited by 37 publications

(32 citation statements)

References 64 publications

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“…A laparoscopy scoring system has been introduced, 26 but the most crucial areas for resectability may be difficult to access with laparoscopy, resulting in hidden areas of carcinomatosis, 27 making it less feasible. A recent Cochrane review 28 concluded that laparoscopy could be a useful tool for identifying women with nonresectable disease, but the reviewed studies included women who had incomplete surgery, with laparoscopy predicting total resectability. Moreover, in recent years, CRS has become more extensive, making evaluation with laparoscopy more difficult.…”

Section: -Specificitymentioning

confidence: 99%

The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer

et al. 2020

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Background Extent of tumor load is an important factor in the selection of ovarian cancer patients for cytoreductive surgery (CRS). The Peritoneal Cancer Index (PCI) gives exact information on tumor load but still is not standard in ovarian cancer surgery. The aim of this study was to find a PCI cutoff for incomplete CRS. The secondary aims were to identify reasons for open-close surgery and to compare surgical complications in relation to tumor burden. Methods The study included 167 women with stage III or IV ovarian cancer scheduled for CRS. Possible predictors of incomplete surgery were evaluated with receiver operator curves, and a PCI cutoff was identified. Surgical complications were analyzed by one-way analysis of variance and Chi square tests. Results The median PCI score for all the patients was 22 (range 3–37) but 33 (range 25–37) for the patients with incomplete surgery (n = 19). The PCI predicted incomplete CRS, with an area under the curve of 0.94 (95% confidence interval [CI], 0.91–0.98). Complete CRS was obtained for 67.2% of the patients with a PCI higher than 24, who experienced an increased rate of complications (p = 0.008). Overall major complications were found in 16.9% of the cases. Only 28.6% of the patients with a PCI higher than 33 achieved complete CRS. The reason for open-close surgery (n = 14) was massive carcinomatosis on the small bowel in all cases. Conclusion The study found PCI to be an excellent predictor of incomplete CRS. Due to a lower surgical success rate, the authors suggest that neoadjuvant chemotherapy could be considered if the PCI is higher than 24. Preoperative radiologic assessment should focus on total tumor burden and not necessarily on specific regions.

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Section: -Specificitymentioning

confidence: 99%

The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer

et al. 2020

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“…A pooled analysis was not possible because of the heterogeneity of the data. Only two of the 18 studies included information on the false-positive rate, that is, laparoscopic assessment of suboptimal tumour reduction was followed by debulking surgery with resulting residual tumour ≤ 1 cm 37 .…”

Section: Discussionmentioning

confidence: 99%

“…Eine gepoolte Analyse war aufgrund der Heterogenität der Daten nicht möglich. Angaben zur Falsch-positiv-Rate, d. h. nach laparoskopischer Einschätzung einer suboptimalen Tumorreduktion folgte eine Debulking-Operation mit resultierendem Tumorrest ≤ 1 cm, wiesen nur 2 der 18 Studien auf [37].…”

Section: Makroskopischer Tumorrest Vs Makroskopische Tumorfreiheitunclassified

The Significance of Preoperative Computed Tomography for Predicting Optimal Cytoreduction in Advanced Ovarian Cancer

Stachs

Engel

Stubert

et al. 2020

Geburtshilfe Frauenheilkd

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Introduction Optimal cytoreduction is the most important prognostic factor in advanced ovarian cancer. Although staging and assessment of operability are made by exploratory surgery, preoperative computed tomography (CT) of the abdomen is regarded as standard. The aim of this study was to examine various CT parameters with regard to prediction of optimal cytoreduction. Patients and Methods The retrospective study included 131 patients with ovarian cancer newly diagnosed between 2010 and 2014. Of these, n = 36 with FIGO stage I to IIB were excluded from the study. A preoperative abdominal CT was available for n = 75 of the 95 patients with FIGO stage IIC to IV. The CT scans underwent blinded review. The 11 evaluated CT parameters were examined by means of χ2 test and logistic regression analysis with regard to the endpoints of macroscopic residual tumour and residual tumour > 1 cm. Survival analyses used the Kaplan-Meier method and log rank test. Results Of 75 patients, 28 (37.3%) had complete tumour resection and 26 (34.7%) had residual tumour ≤ 1 cm. Residual tumours > 1 cm were found in 21 (28%) patients, five of which were not resectable. Overall survival with residual tumour > 1 cm differed significantly from the group with no macroscopic residual tumour (p = 0.003) and with residual tumour ≤ 1 cm (p = 0.04). The CT parameters tumour foci in the diaphragm, mesocolon, greater omentum and peritoneum as well as ascites correlated with macroscopic residual tumour. In the multivariate logistic regression analysis only the CT parameter intraparenchymal liver metastasis was statistically significant with regard to prediction of suboptimal tumour resection (> 1 cm) (OR 8.04; 95% CI 1.57 – 42.4; p = 0.0134). The sensitivity, specificity, PPV and NPV were 37.5, 89.7, 66.7 and 72.2%. Conclusion Although risk parameters for suboptimal tumour reduction can be identified by CT of the abdomen, surgical exploration with histological confirmation of the diagnosis is essential because of the poor diagnostic accuracy.

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“…Therefore, the selection of women who would benefit from PDS may be possible. However, due to the large heterogeneity of the included studies, careful interpretation of the study result is crucial (39). The laparoscopic criteria for the prediction of optimal debulking are summarized in Table 2.…”

Section: Diagnostic Laparoscopymentioning

confidence: 99%

Prediction of optimal debulking surgery in ovarian cancer

Song¹

2021

Gland Surg

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The mainstay management of advanced ovarian cancer is maximal cytoreductive surgery followed by chemotherapy. Neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) are alternative treatments for patients with comorbidity, poor performance status, and predicted for suboptimal debulking surgery. It is the invariable principle in any situation that no residual disease after the completion of surgery is useful for patients with ovarian cancer. Therefore, the prediction of optimal debulking before the treatment of ovarian cancer is of utmost importance. Many studies have reported on the use of serum biomarkers, such as cancer antigen 125 (CA125) or human epididymis 4 (HE4), and imaging studies, such as computed tomography (CT), diffusion-weighted magnetic resonance imaging (DW-MRI), and positron emission tomography (PET)/CT, to identify adequate surgical candidates for primary debulking surgery (PDS). Laparoscopy has also been studied as a reliable tool for the prediction of optimal debulking. Here, we summarize a review of the related literature.

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Laparoscopy for diagnosing resectability of disease in women with advanced ovarian cancer

Cited by 37 publications

References 64 publications

The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer

The Peritoneal Cancer Index is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer

The Significance of Preoperative Computed Tomography for Predicting Optimal Cytoreduction in Advanced Ovarian Cancer

Prediction of optimal debulking surgery in ovarian cancer

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