J Gynecol Oncol.  2023 Mar;34(2):e17. 10.3802/jgo.2023.34.e17.

Role of diagnostic laparoscopy in deciding primary treatment in advanced-stage ovarian cancer

• Lee YJ
• Chung YS
• Lee JY
• Nam EJ
• Kim SW
• Kim YT
• Kim S

• KMID: 2552514
• DOI: http://doi.org/10.3802/jgo.2023.34.e17

Abstract

Objective
We evaluated the usefulness of preoperative diagnostic laparoscopy for treatment planning in patients with advanced-stage ovarian cancer.
Methods
We retrospectively analyzed 614 patients diagnosed with advanced-stage ovarian cancer between January 2010 and May 2018. Primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC) followed by interval debulking surgery were selected based on preoperative laparoscopic (Group 1, n=192) and computed tomography findings (Group 2, n=422). The primary outcomes in the PDS and NAC groups were suboptimal cytoreduction (residual disease >1 cm) rate and non-high-grade serous carcinoma (non-HGSC) rate, respectively.
Results
The patients who underwent PDS in group 1 and group 2 were 49 (25.5%) and 279 (66.1%), respectively. The suboptimal cytoreduction rate after PDS was lower in Group 1 than in Group 2 (2.0% vs 11.1%, p=0.023). Moreover, Group 1 showed a tendency toward a lower proportion of non-HGSC patients who underwent NAC than that in Group 2 (9.1% vs. 15.4%, p=0.069). Further, Group 1 showed lower rates of postoperative morbidity than Group 2 (5.2% vs. 10.4%, p=0.033). However, Kaplan–Meier analysis showed no significant differences in survival outcomes between the 2 groups.
Conclusion
Diagnostic laparoscopy reduced the suboptimal cytoreduction rate in the PDS group and the implementation rate of NAC in non-HGSC patients. Moreover, it reduced postoperative morbidity without affecting survival in both groups. Thus, diagnostic laparoscopy is a valuable diagnostic tool for determining the primary treatment.

Keyword

Ovarian Cancer; Surgical Diagnostic Technique; Cytoreductive Surgery; Neoadjuvant Chemotherapy