Minimally invasive versus standard laparotomic interval debulking surgery in ovarian neoplasm: A single-institution retrospective case-control study

Alletti, Salvatore Gueli; Petrillo, Marco; Vizzielli, Giuseppe; Bottoni, Carolina; Nardelli, Federica; Costantini, Barbara; Quagliozzi, Lorena; Gallotta, Valerio; Scambia, Giovanni; Fagotti, Anna

doi:10.1016/j.ygyno.2016.10.017

Cited by 41 publications

(36 citation statements)

References 19 publications

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“…Based on the current study, we suggest starting surgery with diagnostic laparoscopy and, if feasible, safely continuing by either laparoscopy or robotics to decrease the impact of aggressive surgery on high-morbidity patients, and thus reduce time to chemotherapy 12. This approach has also been found to be cost effective and can be used as a diagnostic tool before primary cytoreductive surgery in ovarian cancer 23.…”

Section: Discussionmentioning

confidence: 99%

The INTERNATIONAL MISSION study: minimally invasive surgery in ovarian neoplasms after neoadjuvant chemotherapy

Fagotti

Alletti

Corrado³

et al. 2019

International Journal of Gynecological Cancer

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ObjectivesThe aim of this retrospective multicenter study was to investigate the extent, feasibility, and outcomes of minimally invasive surgery at the time of interval debulking surgery in different gynecological cancer centers.Methods/MaterialsIn December 2016, 20 gynecological cancer centers were contacted by e-mail, to participate in the INTERNATIONAL MISSION study. Seven centers confirmed and five were included, with a total of 127 patients diagnosed with advanced epithelial ovarian cancer after neoadjuvant chemotherapy and minimally invasive interval surgery. Only women with a minimum follow-up time of 6 months from interval surgery or any cancer-related event before 6 months were included in the survival analysis. Baseline characteristics, chemotherapy, and operative data were evaluated. Survival analysis was evaluated using the Kaplan–Meier method.Results All patients had optimal cytoreduction at the time of interval surgery: among them, 122 (96.1%) patients had no residual tumor. Median operative time was 225 min (range 60 – 600) and median estimated blood loss was 100 mL (range 70 – 1320). Median time to discharge was 2 days (1–33) and estimated median time to start chemotherapy was 20 days (range 15 – 60). Six (4.7%) patients experienced intraoperative complications, with one patient experiencing two serious complications (bowel and bladder injury at the same time). There were six (4.7%) patients with postoperative short-term complications: among them, three patients had severe complications. The conversion rate to laparotomy was 3.9 %. Median follow-up time was 37 months (range 7 – 86): 74 of 127 patients recurred (58.3%) and 31 (24.4%) patients died from disease. Median progression-free survival was 23 months and survival at 5 years was 52 % (95% CI: 35 to 67).ConclusionsMinimally invasive surgery may be considered for the management of patients with advanced ovarian cancer who have undergone neoadjuvant chemotherapy, when surgery is limited to low-complexity standard cytoreductive procedures.

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Section: Discussionmentioning

confidence: 99%

The INTERNATIONAL MISSION study: minimally invasive surgery in ovarian neoplasms after neoadjuvant chemotherapy

Fagotti

Alletti

Corrado³

et al. 2019

International Journal of Gynecological Cancer

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“…Our survey provides support that a segment of the gynecologic oncology community has definite interest in the use of MIS highlighting several perceived benefits of MIS, including reduced patient morbidity and length of hospital stay. Prior studies have documented the safety and efficacy of MIS for staging in presumed early-stage EOC and interval cytoreductive surgery ( Ditto et al, 2017 , Bogani et al, 2017 , Koo et al, 2014 , Gueli Alletti et al, 2016 ). A National Cancer Database case-control study showed no difference in time to death between laparoscopy and laparotomy staging in presumed Stage I EOC ( Melamed et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…A number of recent retrospective studies suggest that laparoscopic surgery is feasible and safe for the treatment of early-stage epithelial OC ( Ditto et al, 2017 , Bogani et al, 2017 , Melamed et al, 2017 , Koo et al, 2014 ); as well as advanced-stage EOC, particularly after patients have received NACT ( Melamed et al, 2017 , Gueli Alletti et al, 2016 , Fagotti et al, 2019 ). Although these studies are retrospective in nature and are limited by small sample sizes, they provide data that lends support to the use of MIS for the treatment of OC; however, there is no current consensus on its widespread use.…”

Section: Introductionmentioning

confidence: 99%

Practice patterns using minimally invasive surgery for the treatment of ovarian cancer: A survey of physician members of the Society of Gynecologic Oncologists

Kremer

Lee

Carlson

et al. 2020

Gynecologic Oncology Reports

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Highlights: Use of MIS for the treatment of early-stage ovarian cancer appears to be common. Gynecologic oncologists show interest in performing advanced laparoscopic procedures. Neoadjuvant chemotherapy may play role in determining use of MIS for ovarian cancer. Barriers to MIS for ovary cancer were concern for occult disease and lack of evidence.

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“…Weaknesses of the current study include the retrospective nature, a limited number of non-serous histologies for subtype analysis, and the lack of control for unmodifiable risk factors such as age, BMI, and comorbidities. Furthermore, the cohort [ 12 ] has a limited number of patients who received neoadjuvant chemotherapy, despite the growing acceptance of this treatment strategy [ 13 – 15 ] hence these patients were excluded. Data is scant on the role of time off treatment for interval cytoreduction as a predictor of survival.…”

Section: Discussionmentioning

confidence: 99%

Prognostic impact of adjuvant chemotherapy treatment intensity for ovarian cancer

et al. 2018

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ObjectiveWe aimed to investigate the prognostic impact of duration of first-line chemotherapy administration in patients with epithelial ovarian cancer (EOC).MethodsChemotherapy records were abstracted from the electronic medical record. Patients with on-time completion (105 days) were compared to patients finishing early (<105 days), delays of 1–4 weeks, or >4 weeks. For 222 women with stage IIIC/IV, stage-stratified estimates of progression-free survival (PFS) and overall survival (OS) were compared. A delay sub-study was performed with outliers removed. Each week of delay was correlated with the change in PFS and OS to identify time points associated with change in outcome.ResultsMost women had on-time completion of chemotherapy (23.6%) or a treatment delay of ≤4 weeks (21.8%); 21.6% of women experienced a delay longer than 4 weeks. R0 resection at initial debulking (OR = 1.99, 95%CI: 1.18–3.36, p = 0.010) and RECIST complete response (OR = 4.88, 95%CI: 2.47–10.63, p<0.001) were strongly associated with on-time completion. Patients with on-time completion and < 1 month delay had similar median survivals of 43.1 months (lower 95% CI bound 33.7 months) and 44.5 months (lower bound 37.0, p = 0.93). Women with >1 month delay had decreased median survival of 18.1 months (14.7–24.9 months), while women with short intervals survived 35.0 months (95%CI: 21.8–49.8 months). Short-term delays lead to progressively decreasing OS. This was significantly different from the on-schedule survival estimate after 6 weeks of delay.ConclusionsOn-time completion of chemotherapy correlates with increased survival and higher complete response rates. Increasing delays in chemotherapy completion were associated with decreased survival.

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Minimally invasive versus standard laparotomic interval debulking surgery in ovarian neoplasm: A single-institution retrospective case-control study

Cited by 41 publications

References 19 publications

The INTERNATIONAL MISSION study: minimally invasive surgery in ovarian neoplasms after neoadjuvant chemotherapy

The INTERNATIONAL MISSION study: minimally invasive surgery in ovarian neoplasms after neoadjuvant chemotherapy

Practice patterns using minimally invasive surgery for the treatment of ovarian cancer: A survey of physician members of the Society of Gynecologic Oncologists

Prognostic impact of adjuvant chemotherapy treatment intensity for ovarian cancer

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