Laparoscopic Surgical Staging of Ovarian Cancer

doi:10.1006/gyno.1995.1263

Gynecologic Oncology

Volume 59, Issue 1, October 1995, Pages 25-33

https://doi.org/10.1006/gyno.1995.1263 Get rights and content

Abstract

The feasibility of laparoscopic staging in patients with ovarian cancer was undertaken prospectively to determine the ability to adequately evaluate both the intraperitoneal cavity and the retroperitoneal lymph nodes. Two groups of ovarian cancer patients were evaluated: those with optimally debulked advanced disease undergoing second-look procedures and those with presumed stage I disease undergoing surgical staging. Twenty-four of the 44 laparoscopic second-look procedures (56%) were positive for persistent disease. Five of these patients had microscopic disease only, in the omentum, washings, pelvic peritoneum, and in para-aortic lymph nodes (2 patients). In the group of 14 patients undergoing staging for presumed early ovarian carcinoma, metastatic disease was discovered in 8 (57%) patients. Two patients had peritoneal washings positive for adenocarcinoma; 3 had pelvic disease, 1 confined to a fallopian tube and 2 to the pelvic peritoneum; and 3 patients had para-aortic lymph nodes positive for metastatic adenocarcinoma. There were no serious complications in this category. The average hospital stay was 1.6 days. Laparoscopic staging appears to be an accurate staging technique, and further investigation into the validity of this approach is warranted.

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Cited by (144)

Role of minimally invasive surgery in gynecologic malignancies
2023, DiSaia and Creasman Clinical Gynecologic Oncology
Minimally invasive surgery (MIS) is practiced by more than 90% of gynecologic oncologists. Knowledge of anatomy, the disease process, and surgical technique is key during these complicated surgical procedures. Several studies have shown that 10 to 20 cases are needed to gain proficiency with a certain procedure. MIS reduces blood loss, transfusions, length of hospital stay, and wound complications without compromising adequacy of the procedure or staging even in (extremely) morbidly obese patients. Survival outcomes for endometrial and ovarian cancer are similar after MIS and laparotomy, while survival outcomes with MIS have been shown to be worse for cervical cancer. Several safe methods exist to extract an enlarged uterus after MIS. Morcellation is not recommended when there is suspicion or proven preinvasive or invasive disease. Laparoscopy can be used in ovarian cancer to assess the extent of disease and chance of complete debulking surgery. MIS in advanced or recurrent ovarian cancer and its utilization in interval debulking is still under investigation, and prospective trials to confirm safety and feasibility are ongoing.
Clinical theranostics applications of photo-acoustic imaging as a future prospect for cancer
2022, Journal of Controlled Release
Photoacoustic imaging (PAI) of biological tissue has been a fast developing biomedical multi-wave imaging modality, after its introduction in the mid90s. PAI couples laser excitation to acoustic detection. Especially, in recent years its significant advantages in onco-surgery has attracted much attention due to its ability to detect malignant tissues. Monitoring cancer angiogenesis, assessment of blood oxygen saturation, functional brain imaging, evaluation of cortical blood volume, detection of skin/conjunctival melanoma depth, assessment of met-hemoglobin, investigating tumor hypoxia andcancer lymph node metastases are some of its promising applications. Moreover, as a real-time monitoring strategy, PAI allows intraoperative imaging of micro-metastases and residual islands in onco-surgery. Herein, we provide a brief introduction to biophysics and fundamentals of PAI, potential novel endogenous and exogenous contrast agents, and novel techniques to develop engineered and targeted contrast agents with theranostic applications. We also summarize the clinical trial pipelines for PAI. Furthermore, we discuss the potential obstacles and limitation of PAI theranostic agents for further clinical applications and strategies to overcome these hurdles.
Surgical and survival outcomes of laparoscopic staging surgery for patients with stage I ovarian cancer
2018, Taiwanese Journal of Obstetrics and Gynecology
Citation Excerpt :
Querleu et al. first reported in 1994 that laparoscopy could be used for the comprehensive restaging of adnexal tumors by allowing infrarenal para-aortic lymphadenectomy [10]. Since then, many investigators have reported on the advantages of laparoscopic surgery for the treatment of early-stage ovarian cancer, which include pain reduction, faster recovery, shorter hospitalization, and early initiation of chemotherapy [11,12]. The retrospective and prospective studies on laparoscopic staging surgery for ovarian cancer have enrolled a relatively small number of patients compared with the studies on cervical cancer and endometrial cancer.
To assess the feasibility and survival outcomes of laparoscopic staging for patients with stage I ovarian cancer.
Consecutive patients who underwent laparoscopic staging surgery for stage I ovarian cancer from January 2002 to December 2014 were evaluated retrospectively by chart review.
Twenty-four patients with mean age 43.9 ± 9.9 years and mean body mass index 24.0 ± 3.8 kg/m² were included, in which 12 (50%) patients were in stage IA and 12 (50%) in stage IC. The histological types included serous in 6 (25%), mucinous in 7 (29.1%), endometrioid in 6 (25%), clear cell in 5 (20.8%) patients. The mean surgical time was 306.4 ± 98.5 min, and the mean blood loss was 204.2 ± 188.6 mL. None of the patients required conversion to laparotomy. The median numbers of resected pelvic and para-aortic lymph nodes were 20 and 4, respectively. One (4.1%) patient encountered bowel injury intraoperatively, and the other 1 (4.1%) patient hydronephrosis postoperatively. The overall survival rate was 95% in the current series in a median follow-up of 31.5 months.
Laparoscopic staging surgery performed for early stage ovarian cancer has better long term survival outcomes than the literature report. Laparoscopic treatment by a trained gynecologic oncologist is an ideal alternative for early stage ovarian cancer with the advantage of minimal invasiveness.
Role of minimally invasive surgery in gynecologic malignancies
2018, Clinical Gynecologic Oncology
Ovarian cancer
2017, Medicine (Spain)
El cáncer de ovario se asocia a una elevada mortalidad, debido a que en la mayoría de las pacientes se diagnostica en estadios avanzados.
La estadificación se establece tras la realización de una cirugía reglada, y supone el principal factor pronóstico de esta enfermedad. En los estadios iniciales el tratamiento será la cirugía, seguida de quimioterapia adyuvante cuando existan factores de riesgo. En los estadios avanzados, la cirugía citorreductora será la primera aproximación terapéutica siempre que sea posible, seguida de quimioterapia. El esquema de tratamiento estándar debe contener al menos un platino y un taxano y, aunque todavía existen controversias, la eficacia podría incrementarse con la administración semanal de paclitaxel, la administración intraperitoneal de la quimioterapia o la adición de bevacizumab a la quimioterapia. En la recaída, la quimioterapia será el tratamiento principal. En la recaída platinosensible el estándar es carboplatino en combinación. En la recaída platinorresistente existen varias opciones de monoquimioterapia. La adición de bevacizumab a la quimioterapia de la recaída incrementa la supervivencia libre de progresión (SLP). El tratamiento de mantenimiento con inhibidores de PARP tras la obtención de una respuesta con quimioterapia en la recaída platino sensible también incrementa la SLP, siendo especialmente eficaces en las pacientes con mutación germinal o somática en los genes BRCA.
Ovarian cancer is associated with high mortality, because the majority of patients are diagnosed at advanced stages.
Staging is set after the completion of formal surgery, and is the main prognostic factor for this disease. In the initial stages, treatment is surgery followed by adjuvant chemotherapy when there are risk factors. In advanced stages, cytoreductive surgery is the first therapeutic approach wherever possible, followed by chemotherapy. The standard treatment regimen should contain at least platinum and taxane and, although it is still controversial, the efficiency could be increased with weekly administration of paclitaxel, intraperitoneal administration of chemotherapy or the addition of bevacizumab to chemotherapy. At relapse, chemotherapy is the main treatment. In the platinum-sensitive relapse is standard carboplatin in combination. In the platinum-resistant relapse there are several options of monochemotherapies. The addition of bevacizumab to relapse chemotherapy increases progression-free survival. Maintenance treatment with PARP inhibitors after obtaining a response with chemotherapy in platinum sensitive relapse also increases progression-free survival, being especially effective in patients with germline or somatic mutation in BRCA genes.
Laparoscopic Versus Laparotomic Surgical Staging for Early-Stage Ovarian Cancer: A Case-Control Study
2016, Journal of Minimally Invasive Gynecology
To evaluate the oncologic outcomes of patients with early-stage ovarian cancer (eOC) managed by laparoscopy or laparotomy in a single high-volume gynecologic cancer center.
Retrospective case-control study (Canadian Task Force classification II-2).
Catholic University of the Sacred Hearth, Rome, Italy.
Data of consecutive women with eOC undergoing comprehensive laparoscopic staging between 2007 and 2013 were matched with a cohort of patients undergoing open surgery between 2000 and 2011. Four-year survival outcomes were analyzed using the Kaplan-Meier method.
Sixty women undergoing staging via laparoscopy were compared with a cohort of 120 patients undergoing open surgery. Baseline characteristics were similar between groups. Seventy percent of patients underwent adjuvant platinum based chemotherapy without differences between the 2 groups. Operative time (p = .01), estimated blood loss (p = .032), and median hospital stay (p = .001) were higher in patients submitted to laparotomic versus laparoscopic staging. As of October 2015, median duration of follow-up was 38 months (range, 24 -48), recurrent disease was documented in 16 patients (13.3%) in the laparotomic group and in 5 patients (8.3%) in the laparoscopic group (p = .651), without differences in the pattern of recurrence presentation. Four-year progression-free survival (PFS) and overall survival (OS) rates were 89% and 92% in the laparoscopic group, respectively, and 81% and 91% in the laparotomic group, without any statistical significant difference between the groups (4-year PFS p = .651; 4-year OS p = .719).
The findings of the present study suggests that in the surgical treatment of FIGO stage I ovarian cancer, laparoscopy is associated with equivalent oncologic outcome compared with a conventional abdominal approach.

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Regular ArticleLaparoscopic Surgical Staging of Ovarian Cancer

Abstract

Regular Article
Laparoscopic Surgical Staging of Ovarian Cancer