Should laparoscopy be included in the work-up of advanced ovarian cancer patients attempting interval debulking surgery?
OBJECTIVE
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.
Fagotti
A
A
Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy. annafagotti@hotmail.com
Fanfani
F
F
Vizzielli
G
G
Gallotta
V
V
Ercoli
A
A
Paglia
A
A
Costantini
B
B
Vigliotta
M
M
Scambia
G
G
Ferrandina
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies