Role of Laparoscopy in Surgical Treatment of Ovarian Malignancies: A Review

• Published in: Indian journal of gynecologic oncology 2024-12, Vol.22 (4), Article 142
• Main Authors: Rao, Thammineedi Subramanyeshwar, Iyer, R. Rajagopalan
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Oncology; Original Article; Surgical Oncology
• ISSN: 2363-8397; 2363-8400
• DOI: 10.1007/s40944-024-00903-z

Background Laparoscopy has a proven role in endometrial and early ovarian cancers. Surgery remains the cornerstone of treatment in ovarian cancer, complete cytoreduction with no macroscopic residual disease being the goal. In advanced ovarian cancers (stage III and IV), the volume of disease and complexity of surgery may preclude the use of laparoscopy for optimal cytoreduction. The extent of surgery decreases significantly in patients with a very good response to chemotherapy. Purpose To define a role of minimal access oncosurgical procedures in ovarian tumors. MAS in ovarian cancers can be broadly divided into. Group I: Advanced ovarian cancers. Conventional staging is through a midline laparotomy from the pubic symphysis to the xiphisternum, to achieve complete cytoreduction with no residual macroscopic disease. Primary optimal cytoreduction is feasible in only 20–50% of patients. Neoadjuvant chemotherapy in patients with advanced ovarian cancers (AOC), reduces the disease bulk facilitating optimal cytoreduction. 2 randomized trials have shown non-inferiority of interval cytoreduction (IC) over primary cytoreduction in AOC (Stage III, IV). Neoadjuvant chemotherapy helps increase the number of optimal cytoreduction’s performed and reduces surgical morbidity. Complete response was seen in 20–30% after neoadjuvant chemotherapy, this group of patients may be amenable to laparoscopic optimal interval cytoreduction Group II: Completion Staging in early ovarian cancer. Women with early ovarian cancer who have undergone ovarian cystectomy/adnexectomy elsewhere or are undergoing laparoscopy-assisted excision and frozen analysis to confirm/exclude malignancy. These women can undergo laparoscopic completion staging (omentectomy, pelvic, infrarenal retroperitoneal lymphadenectomy with/without hysterectomy and removal of contralateral adnexa). Methods A retrospective study of our institute, was done using electronic medical records. All patients who underwent laparoscopic optimal interval cytoreduction for advanced ovarian cancers FIGO Stage IIIC in the period from January 2010 to December 2014 were included in the analysis. Patients of early ovarian cancers, who were operated between the 2013–2020 were included. Results 40 patients of advanced ovarian cancers underwent laparoscopic optimal cytoreduction of which 36 were interval and were included in the analysis. At a median follow-up of 60 months, 3 patients (8.3 %) were lost to follow-up. The overall survival (OS