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Should laparoscopy be included in the work-up of advanced ovarian cancer patients attempting interval debulking surgery?

2009; Elsevier BV; Volume: 116; Issue: 1 Linguagem: Inglês

10.1016/j.ygyno.2009.09.015

1095-6859

Anna Fagotti, Francesco Fanfani, Giuseppe Vizzielli, Valerio Gallotta, Alfredo Ercoli, A. Paglia, Barbara Costantini, M. Vigliotta, Giovanni Scambia, Gabriella Ferrandina,

Endometriosis Research and Treatment

Abstract Objectives Primary: To investigate whether S-LPS could contribute to a better identification of patients to submit to IDS. Secondary: To identify the most appropriate level of laparoscopic index value (PIV) to identify inoperable patients in this subset of patients. Methods A prospective single-institutional study including patients with advanced ovarian/peritoneal cancer (FIGO stage IIIC–IV) to be submitted to IDS after NACT. Patients have been considered eligible for surgical exploration in case of complete/partial radiological or serological response; stable disease if primary surgery had been performed in a different hospital; progressive radiological disease in the presence of serological response, young age, and good performance status (ECOG <1); and progressive serological disease with stable clinical and radiological disease. A laparoscopic assessment for each patient has been performed. Results Ninety-eight consecutive AOC patients submitted to NACT have been eligible for the study. With the addition of S-LPS to the RECIST criteria, a surgical exploration is performed in all patients and the percentage of explorative laparotomies drops to about 10%. The use of S-LPS after the GCIG criteria can reduce the risk of both explorative laparotomies from 30% to 13%, and inappropriate unexplorations from 18% to 0%. Moreover, at a PIV >4 the probability of optimally resecting the disease at laparotomy is equal to 0. Conclusions Present data suggest that S-LPS can play a relevant role to discriminate patients with partially/stable disease or referred from other Institutions after NACT, which can be susceptible of successful IDS.