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- Title
"Things Have Changed"—Laparoscopic Cytoreduction for Advanced and Recurrent Ovarian Cancer: The Experience of a Referral Center on 108 Patients.
- Authors
Ceccaroni, Marcello; Roviglione, Giovanni; Bruni, Francesco; Dababou, Susan; Venier, Martina; Zorzi, Carlotta; Salgarello, Matteo; Ruffo, Giacomo; Alongi, Filippo; Gori, Stefania; Driul, Lorenza; Uccella, Stefano; Barra, Fabio
- Abstract
Simple Summary: Minimally invasive laparoscopic surgeries improve surgical recovery with shorter hospital stays and lower complications. However, the role of minimally invasive surgery in advanced and recurrent ovarian cancer has remained confined to small case series. This retrospective study reports the highest number of patients with advanced and recurrent ovarian cancers undergoing laparoscopic surgery in a single referral center. A rigorous algorithm for the selection of patients has been applied to confirm the feasibility of laparoscopy for primary debulking surgery and broadened its application to interval and secondary debulking surgery. Our study showed that minimally invasive surgery is feasible in select patients with favorable postoperative and oncological outcomes, consistent with other cohorts reported in the literature undergoing traditional laparotomic approach. Objective: To report the feasibility of laparoscopic cytoreduction surgery for primary and recurrent ovarian cancer in a select group of patients. Methods: A retrospective analysis was conducted on a cohort of patients with FIGO stage IIIA-IV advanced ovarian cancer who underwent laparoscopic primary debulking surgery (PDS), interval debulking surgery (IDS), or secondary debulking surgery (SDS) between June 2008 and January 2020. The primary endpoint was achieving optimal cytoreduction, defined as residual tumor less than 1 cm. Secondary endpoints included evaluating surgical complications and long-term survival, assessed at three-month intervals during the initial two years and then every six months. Results: This study included a total of 108 patients, among whom, 40 underwent PDS, 44 underwent IDS, and 24 underwent SDS. Optimal cytoreduction rates were found to be 95.0%, 97.7%, and 95.8% for the PDS, ISD, and SDS groups, respectively. Early postoperative complications (<30 days from surgery) occurred in 19.2% of cases, with 7.4% of these cases requiring reintervention. One patient died following postoperative respiratory failure. Late postoperative complications (<30 days from surgery) occurred in 9.3% of cases, and they required surgical reintervention only in one case. After laparoscopic optimal cytoreduction with a median follow-up time of 25 months, the overall recurrence rates were 45.7%, 38.5%, and 39.3% for PDS, ISD, and SDS, respectively. The three-year overall survival rates were 84%, 66%, and 63%, respectively, while the three-year disease-free survival rates were 48%, 51%, and 71%, respectively. Conclusions: Laparoscopic cytoreduction surgery is feasible for advanced ovarian cancer in carefully selected patients, resulting in high rates of optimal cytoreduction, satisfactory peri-operative morbidity, and encouraging survival outcomes. Future studies should focus on establishing standardized selection criteria and conducting well-designed investigations to further refine patient selection and evaluate long-term outcomes.
- Subjects
OVARIAN tumors; LOG-rank test; MINIMALLY invasive procedures; CANCER relapse; LAPAROSCOPIC surgery; RETROSPECTIVE studies; TUMOR classification; TREATMENT effectiveness; DESCRIPTIVE statistics; KAPLAN-Meier estimator; SURVIVAL analysis (Biometry); CYTOREDUCTIVE surgery; DATA analysis software; LONGITUDINAL method
- Publication
Cancers, 2023, Vol 15, Issue 24, p5726
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers15245726