Abstract
BackgroundThe aims of this retrospective study were to evaluate laparoscopic triage of patients with advanced ovarian cancer towards primary surgery or neoadjuvant chemotherapy, and to analyze outcome according to the treatment.MethodsBetween January 2001 and December 2006, 55 patients with stage III – IV ovarian cancer underwent diagnostic laparoscopy. Primary surgery was performed when complete cytoreduction was considered feasible, while the other patients received neoadjuvant chemotherapy (platinum-based combination with taxanes) and interval surgery. All the patients received adjuvant chemotherapy.ResultsPatients treated with neoadjuvant chemotherapy (n = 29) had a higher mean body mass index (P = 0.048), higher serum CA 125 levels (P = 0.026), and more metastases (P = 0.045) than patients treated with primary surgery (n = 26). In patients treated with primary surgery, complete cytoreduction and a residual tumour size ≤ 2 cm were obtained in respectively 54% and 77% of cases. Complete cytoreduction was achieved in respectively 100% and 33% of cases when primary surgery was performed by an oncologic gynaecologist and by a non-oncologic gynaecologist (P = 0.002). Interval surgery yielded complete cytoreduction and a residual tumour size ≤ 2 cm in respectively 73% and 85% of cases. With a median follow-up of 24 months (range 7 – 78 months), the survival rates after primary surgery and interval surgery were 61% and 66% respectively.ConclusionDiagnostic laparoscopy is useful for identifying patients with stage III/IV ovarian cancer who qualify for primary cytoreduction. Surgeon experience was a determining factor for the success of complete cytoreduction.
Highlights
The aims of this retrospective study were to evaluate laparoscopic triage of patients with advanced ovarian cancer towards primary surgery or neoadjuvant chemotherapy, and to analyze outcome according to the treatment
Characteristics of the patients undergoing primary surgery and neoadjuvant chemotherapy Among the 55 patients referred to our department for laparoscopic evaluation of stage III – IV ovarian cancer, 26 patients underwent primary surgery after diagnostic laparoscopy
Patients treated with neoadjuvant chemotherapy had a higher body mass index (BMI), a higher serum CA 125 level, and more metastases than patients treated with primary surgery
Summary
The aims of this retrospective study were to evaluate laparoscopic triage of patients with advanced ovarian cancer towards primary surgery or neoadjuvant chemotherapy, and to analyze outcome according to the treatment. The extent of cytoreductive surgery and the amount of residual tumour are the most important survival determinants in patients with advanced ovarian cancer [1,2]. BMC Cancer 2009, 9:171 http://www.biomedcentral.com/1471-2407/9/171 chemotherapy with interval cytoreduction has emerged as an alternative to primary surgery. This delayed strategy does not seem to compromise survival [3,4]. Neoadjuvant chemotherapy is an acceptable alternative for patients with unresectable disease, Bristow et al have stressed that survival appears to be poorer after initial chemotherapy than after successful up-front cytoreductive surgery [5]. Several predictive models have been proposed, based on clinical findings (ascites, etc.), imaging, and the CA125 serum level, but false-positive rates range from 5% to 37% and surgical evaluation is crucial [6,7,8]
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