The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced-stage ovarian, fallopian tube, and primary peritoneal cancers.

Nezhat, Farr; DeNoble, S.M.; Liu, Connie; Cho, Jennifer E; Brown, Douglas; Chuang, Linus; Gretz, Herbert; Saharia, Prakash C.

doi:10.1200/jco.2010.28.15_suppl.e15527

Cited by 6 publications

(12 citation statements)

References 26 publications

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“…In the following years, reports emerged demonstrating the feasibility of the laparoscopic management of ovarian cancer, but its use has been largely limited to surgeries for diagnosis as well as the assessment of resectability and second-look procedures,25 27–29 and in the staging of select cases of early-stage disease 24 28 30–34. Some studies have also reported on laparoscopic cytoreduction in highly selected patients with advanced ovarian cancer 14–17…”

Section: Discussionmentioning

confidence: 99%

“…The use of neoadjuvant chemotherapy followed by interval surgical cytoreduction and adjuvant chemotherapy has become an option for some women with advanced ovarian cancer, offering comparable survival8–11 and decreased morbidity9–13 compared with upfront cytoreductive surgery. Preliminary studies have laid the groundwork on the feasibility of minimally invasive interval cytoreductive surgery in selected patients after neoadjuvant chemotherapy 14–20. Since the Food and Drug Administration’s approval of the da Vinci Surgical System for gynecologic procedures in 2005, it has rapidly integrated into the treatment of uterine cancer and, like laparoscopy, has resulted in reduced operative blood loss, lower incidence of post-operative complications, and faster recovery 21 22…”

Section: Introductionmentioning

confidence: 99%

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Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

Abitbol

Gotlieb

Zeng

et al. 2019

International Journal of Gynecological Cancer

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IntroductionWith the rapid uptake of robotic surgery in surgical oncology, its use in the treatment of epithelial ovarian cancers is being evaluated. Complete cytoreduction represents the goal of surgery either at primary cytoreduction or after neoadjuvant chemotherapy in the setting of interval cytoreduction. In selected patients, the extent of disease would enable minimally invasive surgery. The objective of this study was to evaluate the impact of introducing robotic surgery for interval cytoreduction of selected patients with stage III–IV ovarian cancer.MethodsAll patients who underwent surgery from November 2008 to 2014 (concurrent time period when robotic and open surgery were used simultaneously) after receiving neoadjuvant chemotherapy for advanced ovarian cancer (stage III–IV) were compared with all consecutive patients who underwent cytoreductive surgery by laparotomy after neoadjuvant chemotherapy between January 2006 and November 2008. Inclusion criteria included an interval cytoreductive surgery by laparotomy or robotic assistance for stage III–IV non-mucinous epithelial ovarian, fallopian tube, or primary peritoneal cancer. Exclusion criteria included patients treated concurrently for a non-gynecologic cancer, as well as secondary cytoreductive surgeries and diagnostic surgeries without an attempt at tumor reduction. Overall survival, progression-free survival, and peri-operative outcomes were compared for the entire patient cohort with those with advanced ovarian cancer who received neoadjuvant chemotherapy immediately before and after the introduction of robotic surgery.ResultsA total of 91 patients were selected to undergo interval cytoreduction either via robotic surgery (n=57) or laparotomy (n=34) after the administration of neoadjuvant chemotherapy. The median age of the cohort was 65 years (range 24–88), 78% had stage III disease, and the median follow-up time was 37 months (5.6–91.4 months). The median survival was 42.8±3.1 months in the period where both robotic surgery and laparotomy were offered compared with 37.9±9.8 months in the time period preceding when only laparotomy was performed (p=0.6). All patients selected to undergo interval robotic cytoreduction following neoadjuvant chemotherapy had a reduction of cancer antigen 125 by at least 80%, resolution of ascites, and CT findings suggesting the potential to achieve optimal interval cytoreduction. All these patients achieved optimal cytoreduction with <1 cm residual disease, including 82% with no residual disease. The median blood loss was 100 mL (mean 135 mL, range 10–1250 mL), and the median hospital stay was 1 day.ConclusionRobotic interval cytoreductive surgery is feasible in well-selected patients. Future studies should aim to define ideal patients for minimally invasive cytoreductive surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

Abitbol

Gotlieb

Zeng

et al. 2019

International Journal of Gynecological Cancer

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“…Case 6 presented for restaging, after prior left salpingo-oophorectomy and staging. Among the 11 cases operated for advanced and/or recurrent ovarian cancer, the mean age was 63.9 years (range, 39-92), average BMI was 29.7 kg/m 2 (range, 22.1-37.2), EBL was 129.1 ml (range, 20-400), operating room time was 238 min (range, 103-477), and LOS was 3.8 days (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. In this group, surgical procedures consisted of six hysterectomies, five oophorectomies, eight omentectomies, three pelvic lymph node dissections (average, 10.7; range, 4-18), three para-aortic lymph node dissections (average, 5; range, 1-9), four appendectomies, five diaphragmatic biopsies, four upper abdominal debulking or diaphragmatic debulking, and one resection of a porta hepatis mass (Table 2; case 10; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Thorough four-quadrant abdominopelvic cavity evaluation was performed by inserting additional ports, when necessary, to implement the choice of treatment. If surgical debulking to no visible disease is not possible, then biopsies are taken and salpingo-oophorectomy is performed if feasible [11,12]. The procedure is terminated and the patient is given neoadjuvant chemotherapy to achieve higher rate of optimal cytoreductive surgery and decrease morbidity [13].…”

Section: Techniquementioning

confidence: 99%

A hybrid technique of combined conventional and robotic-assisted laparoscopy for staging and debulking of early, advanced, and recurrent ovarian, fallopian tube, and primary peritoneal cancer

et al. 2013

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This study aims to describe a hybrid laparoscopic and robotic-assisted laparoscopic technique to access all four abdominal quadrants during pelvic procedures. This technique was utilized in the surgical management of select cases that included early, advanced, and recurrent ovarian, fallopian tube, and peritoneal cancer. A retrospective analysis of a prospectively maintained database was used to extract cases that this surgical method was utilized in. This included 20 patients that underwent 21 surgical procedures using this hybrid technique of conventional laparoscopy and robotic-assisted laparoscopy. Ten were early stage, and 11 were advanced and/or recurrent (six advanced, five recurrent). In the early-stage group, mean age was 42.3 years (range, 29-55), average BMI was 32.1 kg/ m 2 (range, 17-65 kg/m 2), mean blood loss was 212.5 ml (range, 50-1,000 mL), operating room time (ORT) was 306.1 min (range, 87-639), and average length of stay (LOS) was 1.6 days (range, 1-2). There were no intraoperative complications and two grade 1 postoperative complications. Of the 11 for advanced and/or recurrent disease, mean age was 63.9 years (range, 39-92), average BMI was 29.7 kg/m 2 (range, 22.1-37.2), mean blood loss was 129.1 ml (range, 20-400), ORT was 238 min (range, 103-477), and LOS was 3.8 days (range, 1-17). There were no intraoperative complications. Three cases had postoperative grade 1-3 complications. There was one second look, nine cytoreductions to no visible disease, and 1 to <0.5 cm. Use of this hybrid technique, combining conventional laparoscopy and the present robotic platform, is effective in the surgical management of early, advanced and recurrent ovarian, fallopian tube, and peritoneal cancer in accessing all four abdominal quadrants with pelvic surgery.

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“…In one report of 32 patients with the International Federation of Gynecology and Obstetrics stage 2C or greater ovarian cancer who were evaluated with TL prior to their debulking procedure, 17 patients were laparoscopically debulked, 88.2% of whom were cytoreduced to less than 0.5 cm. Notably, comorbid medical conditions, not technical inability, accounted for the two that were not optimally cytoreduced [19]. The first RAL hysterectomy with BSO on a human was part of a RAL ovarian cancer staging including PPALND and an infracolic omentectomy [8].…”

Section: Applications Of Mis In Gonmentioning

confidence: 99%

Minimally Invasive Surgery in Gynecologic Oncology: A Review of Modalities and the Literature

Jernigan

Auer

Fader

et al. 2012

Womens Health (Lond Engl)

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Minimally invasive surgery is one of the newest and most exciting areas of development in procedural medicine. This field shows tremendous potential to increase therapeutic benefit while minimizing some of the painful or dangerous side effects of surgical interventions. Minimally invasive surgery has strong historic ties to the field of gynecology and has come a long way as technology and techniques have improved. This has increasingly allowed the application of laparoscopy to more complex procedures and the treatment of gynecologic malignancies. Three laparoscopic approaches, traditional laparoscopy, robotic assisted laparoscopy and laparoendoscopic single-site surgery are reviewed here. We discuss the basic approaches to these three laparoscopic techniques, and then review their applications in gynecologic oncology. We also touch on the evidence behind outcomes associated with their use.

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The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced-stage ovarian, fallopian tube, and primary peritoneal cancers.

Cited by 6 publications

References 26 publications

Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

Incorporating robotic surgery into the management of ovarian cancer after neoadjuvant chemotherapy

A hybrid technique of combined conventional and robotic-assisted laparoscopy for staging and debulking of early, advanced, and recurrent ovarian, fallopian tube, and primary peritoneal cancer

Minimally Invasive Surgery in Gynecologic Oncology: A Review of Modalities and the Literature

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