When Less Is More: Minimally Invasive Surgery Compared with Laparotomy for Interval Debulking After Neoadjuvant Chemotherapy in Women with Advanced Ovarian Cancer

Brown, Jubilee; Drury, Lane; Crane, Erin K.; Anderson, William E.; Tait, David L.; Higgins, Robert V.; Naumann, R. Wendel

doi:10.1016/j.jmig.2018.09.765

Cited by 33 publications

(31 citation statements)

References 36 publications

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“…In this study, we enrolled 19 observational studies ( Figure 1 ) [ 6 , 11 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. In total, 7213 patients were included in this meta-analysis: 2285 (32%) in the minimally invasive surgery group and 4928 (68%) in the open surgery group.…”

Section: Resultsmentioning

confidence: 99%

Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis

Jochum

Vermel

Faller

et al. 2020

JCM

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As regards ovarian cancer, the use of minimally invasive surgery has steadily increased over the years. Reluctance persists, however, about its oncological outcomes. The main objective of this meta-analysis was to compare the three and five-year mortality of patients operated by minimally invasive surgery (MIS) for ovarian cancer to those operated by conventional open surgery (OPS), as well as their respective perioperative outcomes. PubMed, Cochrane library and CinicalTrials.gov were systematically searched, using the terms laparoscopy, laparoscopic or minimally invasive in combination with ovarian cancer or ovarian carcinoma. We finally included 19 observational studies with a total of 7213 patients. We found no statistically significant difference for five-year (relative risk (RR) = 0.89, 95% CI 0.53–1.49, p = 0.62)) and three-year mortality (RR = 0.95, 95% CI 0.80–1.12, p = 0.52) between the patients undergoing MIS and those operated by OPS. When five and three-year recurrences were analyzed, no statistically significant differences were also observed. Analysis in early and advanced stages subgroups showed no significant difference for survival outcomes, suggesting oncological safety of MIS in all stages. Whether the surgery was primary or interval debulking surgery in advanced ovarian cancer, did not influence the comparative results on mortality or recurrence. Although the available studies are retrospective, and mostly carry a high risk for bias and confounding, an overwhelming consistency of the evidence suggests the likely effectiveness of MIS in selected cases of ovarian cancer, even in advanced stages. To validate the use of MIS, the development of future randomized interventional studies should be a priority.

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Section: Resultsmentioning

confidence: 99%

Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis

Jochum

Vermel

Faller

et al. 2020

JCM

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“…In recent years there has been an impetus to improve surgical care and oncologic outcomes in women who are not optimal candidates for primary cytoreductive surgery, and then undergo NACT followed by IDS [ 6 , 7 , 10 , 12 , 18 , 19 ]. Recent studies have demonstrated that MIS IDS may be considered as an alternative to LAP in carefully selected patients [ [6] , [10] , [11] , [12] , [18] , [19] , [20] , [21] ]. In addition, in a randomized phase 3 trial, HIPEC at the time of IDS for stage III EOC was associated with an OS benefit of 11.8 months, compared to IDS alone [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…MIS has become increasingly utilized to care for patients with gynecologic cancer, including women undergoing IDS for EOC [ 6 , [10] , [11] , [12] , 18 , 19 ]. In retrospective study by Brown et al, 53 patients who had MIS IDS experienced decreased blood loss, shorter hospital stay, and comparable rates of perioperative adverse events compared to 104 women who underwent LAP [ 10 ]. Regarding oncologic outcomes, multiple non-randomized studies have demonstrated comparable rates of optimal cytoreduction, RFS and OS for IDS with MIS compared to LAP [ 6 , 10 , 12 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…Similarly, minimally invasive surgical (MIS) approaches to IDS have been evaluated. Utilizing MIS for IDS has shown comparable short-term OS and improved perioperative outcomes, including shorter hospital stay, decreased blood loss and return to chemotherapy [ 6 , [10] , [11] , [12] ]. However, feasibility and perioperative outcomes following MIS with HIPEC at the time of IDS are yet to be described in women with advanced EOC, compared to LAP.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Assessing feasibility and perioperative outcomes with minimally invasive surgery compared with laparotomy for interval debulking surgery with hyperthermic intraperitoneal chemotherapy for advanced epithelial ovarian cancer

Morton

Chambers

Costales

et al. 2021

Gynecologic Oncology

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Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy in High-Grade Epithelial Ovarian Cancer

Rauh-Hain,

Melamed,

Pareja

et al. 2024

JAMA Netw Open

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ImportanceDespite the absence of high-quality evidence of its safety and effectiveness, minimally invasive surgery (MIS) is increasingly used to treat advanced epithelial ovarian cancer (EOC).ObjectiveTo assess the feasibility of conducting a full-scale randomized clinical trial (RCT) designed to compare the efficacy of MIS vs laparotomy in patients with advanced-stage EOC and a complete or partial response to neoadjuvant chemotherapy (NACT).Design, Setting, and ParticipantsThis lead-in pilot phase of LANCE (Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy), an international, open-label, noninferiority RCT, opened to enrollment in September 2020 and enrolled the 100th eligible patient in February 2023. It was conducted at 11 academic cancer centers in North America and Europe. Participants were adults with stage IIIC or IV epithelial ovarian, fallopian, or primary peritoneal carcinoma who had normal cancer antigen 125 levels and at least a partial radiologic response after 3 to 4 cycles of NACT. Patients were randomly assigned to receive either interval cytoreductive surgery performed using MIS or laparotomy. Data analysis was based on the evaluable population.InterventionsThe MIS arm underwent laparoscopic or robotic surgery, vs laparotomy for the control arm. Resection of all visible tumor was attempted, and conversion from MIS to laparotomy was performed when necessary to attain complete resection.Main Outcomes and MeasuresTrial feasibility was defined by 3 primary end points: patient accrual rate of at least 5.6 patients per month by the last month of the lead-in pilot phase, conversion from MIS to laparotomy in less than 25% of patients, and a difference in complete gross resection rates of fewer than 20 percentage points between study arms.ResultsOne hundred women (median [IQR] age, 63 [39-82] years) were included, of whom 49 were randomly assigned to MIS and 51 to laparotomy; 95 were evaluable for surgical outcomes. Most patients (34 [67%] in the laparotomy arm, and 33 [67%] in the MIS arm) had stage IIIC cancer. The monthly accrual rate reached 5.9 patients per month in the final month of the study. Six of 48 evaluable patients (12.5%; 95% CI, 4.7%-25.2%) assigned to MIS underwent conversion to laparotomy. Surgeons achieved a complete gross resection rate in 42 of 48 evaluable patients (88%) assigned to MIS and in 39 of 47 patients (83%) assigned to laparotomy (difference, 4.5 [95% CI, −9.7 to 18.8] percentage points).Conclusions and RelevanceResults of this lead-in pilot study indicated the feasibility of the LANCE RCT to compare the oncological outcomes of MIS vs laparotomy.Trial RegistrationClinicalTrials.gov Identifier: NCT04575935

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When Less Is More: Minimally Invasive Surgery Compared with Laparotomy for Interval Debulking After Neoadjuvant Chemotherapy in Women with Advanced Ovarian Cancer

Cited by 33 publications

References 36 publications

Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis

Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis

Assessing feasibility and perioperative outcomes with minimally invasive surgery compared with laparotomy for interval debulking surgery with hyperthermic intraperitoneal chemotherapy for advanced epithelial ovarian cancer

Laparoscopic Cytoreduction After Neoadjuvant Chemotherapy in High-Grade Epithelial Ovarian Cancer

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