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Debate 12B - Should Laparoscopic Modalities be Routinely Utilized for Assessment of Resectability prior to Attempted Primary Debulking in Patients with Advanced Ovarian Cancer?

No

from Section III - Ovarian Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

The decision to proceed with primary debulking surgery is complex and depends on multiple factors including patient (age, performance, and nutrition status), center (surgeon/team expertise, volume, ancillary services) and disease factors. Routine laparoscopy has been proposed to assess disease factors: specifically, extent of disease and complexity of surgery required for successful resection. However, laparoscopy requires additional OR time and equipment, lacks sensitivity, and does not accurately assess several of the most agreed upon barriers to successful cytoreduction. Standardized laparoscopic scoring systems have demonstrated high specificity to predict suboptimal debulking, but primarily in single institution studies. These systems are difficult to validate externally, likely due to differing non-disease-related factors. We favor a multi-modality approach beginning with careful patient and center selection and pre-operative imaging. Suitable candidates then undergo exploration via mini-laparotomy at the time of planned debulking surgery to minimize morbidity while maximizing oncologic outcomes.

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Chapter
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Publisher: Cambridge University Press
Print publication year: 2023

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References

Sircar, S, et al. Mini-laparotomy in advanced ovarian cancer. Gynecol Surg 2011;9:179183.CrossRefGoogle Scholar
Fleming, N, et al. Laparoscopic algorithm to triage the timing of tumor reductive surgery in advanced ovarian cancer. Obstet Gynecol 2018;132(3):545554.CrossRefGoogle ScholarPubMed
Fagotti, A, et al. A multicentric trial (Olympia-MITO 13) on the accuracy of laparoscopy to assess peritoneal spread in ovarian cancer. Am J Obstet Gynecol 2013;209(5):462.e1–462.e11.90CrossRefGoogle ScholarPubMed
Kumar, A, et al. Models to predict outcomes after primary debulking surgery: independent validation of models to predict suboptimal cytoreduction and gross residual disease. Gynecol Oncol 2019;154(1):7276.CrossRefGoogle ScholarPubMed
Narasimhulu, DM, et al. Using an evidence-based triage algorithm to reduce 90-day mortality after primary debulking surgery for advanced epithelial ovarian cancer. Gynecol Oncol 2019;155(1):5862.CrossRefGoogle ScholarPubMed

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