Abstract
ObjectivesTo assess the feasibility and outcome of primary laparoscopic cytoreductive surgery on advanced epithelial ovarian cancer in comparison with conventional open surgery.Materials and MethodsPatients undergoing primary laparoscopic cytoreductive surgery (LCS) from March 2007 to December 2016 were matched to controls treated with laparotomic cytoreduction during the same period. Procedural data and outcomes were analyzed.ResultsThe LCS group (n = 64) and laparotomic group (n = 68) had similar age, BMI, stages, histologic type and grading. The LCS group exhibited significantly less operating time (P < 0.001), less intraoperative blood loss (P < 0.001), and shorter time to recover postoperatively (P = 0.002). No statistical difference was observed for the number of pelvic and para-aortic lymph nodes dissected (P = 0.326 and P = 0.151). Significant difference was observed in satisfaction of the cytoreduction (95.3% vs. 76.5%, P = 0.008). No significant difference were observed either in intra-operative or in post-operative complications between the two groups (P = 0.250). Three patients in the LCS group experienced intra-operative complications (4.7%) and were all treated laparoscopically. The conversion rate was 3.1%. No significant differences were observed in the progression-free survival and overall survival between the two groups during the medium follow-up of 18 months (P = 0.236 and P = 0.216). The 2-year and 3-year progression-free survival was 67.9%, 55.5% in LCS group and 53.8%, 33.3% respectively in the control group. The 2-year and 3-year overall survival was 95.8%, 88.7% respectively in the LCS group and 89.0%, 83.7% in the control group.ConclusionsPrimary laparoscopic cytoreductive surgery in some strictly selected advanced stages of EOC patients was feasible and safe, resulting in oncologic outcomes not inferior to those in open surgery.
Highlights
Ovarian cancer has the highest mortality in all the gynecological malignancies
Significant difference was observed in satisfaction of the cytoreduction (95.3% vs. 76.5%, P = 0.008)
In order to overcome the above problems, some randomized controlled trial studies have demonstrated that patients with optimal cytoreduction after neoadjuvant chemotherapy have approximately the same survival rate as patients optimally cytoreduced at primary debulking surgery [5]
Summary
Ovarian cancer has the highest mortality in all the gynecological malignancies. Epithelial ovarian cancer (EOC) is the most common and lethal subtype. Procedural challenges include separation of local adhesions, treatment of massive bleeding when it occurs, resection of the omentum heavily burdened by metastases, and resection of metastatic lesions on the diaphragm or other difficult sites. These challenges have hindered the adoption of laparoscopic techniques, and so far, only limited data on primary laparoscopic cytoreduction for advance stage EOC have been published [2,3,4]. Primary debulking surgery with optimal cytoreduction followed by platinum based chemotherapy is still the current first line treatment in patients with advanced ovarian cancer.
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