Review ArticleRole of Minimally Invasive Surgery in Ovarian Cancer
Section snippets
Laparoscopic Evaluation, Diagnosis, and Staging of Apparent Early Ovarian Cancer
Early ovarian cancer is defined as cancer limited to 1 or both ovaries corresponding to FIGO stage I. Traditionally, staging surgery has been performed via a vertical midline incision, which provides excellent exposure of the upper abdomen, diaphragmatic surfaces, and pelvis. Meticulous surgical staging leads to upstaging in 16% to 35% of presumed early-stage ovarian carcinoma [10].
Several retrospective and case series reports have demonstrated the feasibility and safety of a laparoscopic
Minimally Invasive Surgery for Cytoreduction of Advanced Ovarian Cancer
There is a paucity of data on laparoscopic cytoreductive surgery for advanced ovarian cancer. The first report of successful videolaparoscopic cytoreduction of advanced ovarian cancer was a case series that included 3 patients, all of whom underwent successful total laparoscopic primary or secondary cytoreduction [8].
In 2010, Nezhat et al [17] reported a series of 32 patients with advanced ovarian, fallopian tube, or primary peritoneal cancer who underwent laparoscopic evaluation for debulking.
Hand-Assisted Laparoscopy
Krivak et al [19] reported 25 patients with ovarian carcinoma who underwent surgical staging and cytoreduction via hand-assisted laparoscopy. Six patients had apparent advanced ovarian cancer at referral, and of the 19 patients with presumed early-stage cancer, the disease was upgraded in 5 patients on the basis of retroperitoneal lymph node involvement. In 3 the disease had metastasized to other pelvic structures, and 2 had microscopic disease in the omentum. Twenty-two surgical procedures
Robotic-Assisted Laparoscopy
Recently, there have been reports of use of robotic-assisted surgery in patients with advanced ovarian cancer. In a retrospective case-control study, Magrina et al [20] compared 25 patients with ovarian cancer undergoing a robotic-assisted approach with 27 similar patients undergoing conventional laparoscopy and 119 undergoing laparotomy. In the respective groups, 60%, 75%, and 87% of patients were found to have FIGO stage III/IV disease, and the remaining patients had FIGO stage I/II disease.
Laparoscopic Assessment of Feasibility of Upfront Optimal Surgical Cytoreduction
The mainstay of treatment for advanced invasive epithelial ovarian cancer is ideally cytoreduction to no visible disease (microscopic) followed by platinum-based combination chemotherapy [6], which is associated with the best survival 21, 22, 23, 24. However, cytoreduction to microscopic disease is not possible in all patients at the initial surgery. To increase the rate of complete or optimal debulking and to limit perioperative morbidity, neoadjuvant chemotherapy with interval cytoreduction
Laparoscopic Reassessment or Second-Look Surgery
In the past, second-look surgery was suggested as part of the therapeutic triage in patients with advanced ovarian cancer. Today this procedure is performed primarily in clinical trials or in selected cases with uncertain clinical response of patients. The minimally invasive approach had been used in second-look assessment in patients with a complete clinical response to platinum-based combination chemotherapy. Disease recurrence after negative second-look surgery was reported to be similar for
Laparoscopic Assessment and Cytoreduction of Recurrent Disease
The role of secondary cytoreduction surgery to treat recurrent ovarian carcinoma is debatable. Recently, several authors have suggested some criteria including isolated recurrence, lack of ascites, and optimal debulking at the primary surgery as indications for secondary debulking 33, 34. In these selected cases, laparoscopic secondary cytoreduction has been reported in case reports and series, with acceptable results insofar as efficacy and outcomes 8, 35, 36, 37, 38 (Fig. 2).
Trinh et al [36]
Conventional Laparoscopy
Closed or open transumbilical or left upper quadrant (Palmer point) entry using a Veress needle is used most often. A 0-degree laparoscope, and at times a 30-degree laparoscope, is used via a port placed 4 to 5 cm supraumbilically. We use three 5- to 12-mm ancillary ports in the mid–lower abdomen when the primary lesion is below the pelvic brim. Additional upper abdominal ports can be placed for extensive upper abdominal debulking. Pelvic washings are collected for cytologic analysis, and
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