Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma

Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial

“…Therefore, as a practical rule, the calculation of the rate of inappropriate unexploration can be carried out from our models, as the inverse of PPV and therefore will be 0% at the cutoff values of 7 and 4, in Models 2 and 4, respectively. Finally, more sophisticated imaging approaches such as Positron emission tomography/computed tomography (PET/CT) (Risum et al, 2008), as well as laparoscopic approaches (LPS) scores (Fagotti et al, 2006(Fagotti et al, , 2008Brun et al, 2008) have been recently investigated in terms of prediction of surgical outcome in advanced ovarian cancer, whereas the results of PET/CT seem currently too preliminary to draw any definitive conclusion, data from pilot and prospective studies proposed open LPS as a reliable and flexible predictive tool scores (Fagotti et al, 2006(Fagotti et al, , 2008Brun et al, 2008). Although the accuracy of LPS in the assessment of specific sites of disease involvement is expectedly higher compared with CT scan (Fagotti et al, 2006(Fagotti et al, , 2008Brun et al, 2008), the clinical impact of whether triaging or not advanced ovarian cancer patients to laparotomy on the basis of LPS findings urgently requires to be investigated in controlled clinical trials.…”

“…In this context, much attention has been focused on laboratory assay, clinical and radiographic parameters, or, more recently, laparoscopically assessed scores (Fagotti et al, 2006(Fagotti et al, , 2008Brun et al, 2008) able to preoperatively define each patient's chance to undergo optimal cytoreduction. Although the accuracy of preoperative serum Ca125 levels ranges between 50 and 78%, and conflicting data about the predictive ability of Ca125 levels have been reported (Chi et al, 2000(Chi et al, , 2009Cooper et al, 2002;Saygili et al, 2002;Memarzadeh et al, 2003), computed tomography(CT) scan assessed parameters might conceivably offer better predictive performances, as they define not only the extension of disease, but also more important, the involvement of specific intraabdominal sites generally recognised to heavily preclude the feasibility of optimal debulking, such as portal triad disease, agglutinated bowel/mesentery, bulky diaphragmatic disease, or suprarenal aortic lymph nodes (Eisenkop and Spirtos, 2001).…”

Laparoscopic Splenectomy as Quaternary Cytoreduction for Isolated Parenchymal Splenic Recurrence of Epitelial Tubo-Ovarian Cancer: Report of a Case and Literature Review

“…Staging laparoscopy has proved to offer a reliable evaluation of occult peritoneal carcinosis, and a good prediction of the possibility of optimal cytoreduction in primary and recurrent ETOC patients [24,25,26]. Conversely, retroperitoneal and intraparenchymal localizations of disease may be missed by laparoscopic exploration.…”

Different Degrees of Small Bowel Involvement in Peritoneal Carcinomatosis may Predict the Completeness of Cytoreduction Score. Is there a Role for Staging Laparoscopy?

“…Fagotti et al [19] used the specific sites of disease determined by laparoscopy to calculate the predictive index of successful cytoreduction or to determine which patients would undergo unnecessary exploration. [19]. Vergote et al [20] described 77 patients with clinical and radiological findings predictive of unresectable advanced ovarian cancer PC, by imaging criteria that underwent laparoscopy to evaluate the ability for cytoreduction [20].…”