title: Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy.
abstract: BACKGROUND
  Presently, the use of laparoscopy in advanced ovarian cancer (AOC) is extremely controversial. In the era of neoadjuvant chemotherapy (NACT), endoscopic debulking surgery could be a reasonable alternative for selected patients with primarily unresectable disease.
  
  
  OBJECTIVE
  To evaluate the feasibility as well as the operative and oncologic safety of laparoscopic debulking surgery in patients with AOC submitted to NACT.
  
  
  METHODS
  This is a pilot observational study on initially unresectable, high-grade serous ovarian cancer treated with a sequence of 6 cycles of carboplatin and paclitaxel followed by debulking surgery performed by laparoscopy (group 1) or laparotomy (group 2). The inclusion criteria were clinical complete response, CA-125 normalization, imaging without disease in critical areas, and optimal cytoreduction.
  
  
  RESULTS
  From January 2011 to March 2014, 21 patients were included. Ten women underwent laparoscopy and 11 laparotomy. No epidemiological or oncologic differences were observed between the groups. No surgery-related casualties, intraoperative complications, conversion to laparotomy, or excessive blood loss or transfusion was detected in the laparoscopic procedures. The mean time of operation was 292 min. The length of hospital stay averaged 3.6 days. Two women in group 1 developed relevant complications. After a mean follow-up of 20 months, the recurrence rates were similar, i.e. 80% in group 1 versus 88% in group 2. Although statistical significance was not reached, the mortality related to cancer was considerably higher (20 vs. 0%; p = 0.086) and the mean chemotherapy-free interval was markedly shorter in group 1 (13.3 vs. 20.5 months; p = 0.288).
  
  
  CONCLUSIONS
  Laparoscopic optimal debulking surgery after NACT is feasible and effective in selected patients. Nevertheless, laparoscopy was substantially associated with inferior oncologic results. Endoscopic cytoreduction in AOC should be cautiously suggested until larger prospective trials confirm the observed results.
authors.affiliation: Department of Gynecology, Instituto do Câncer do Estado de São Paulo - ICESP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Favero
authors.forename: Nathalia
authors.initials: N
authors.lastname: Macerox
authors.forename: Tatiana
authors.initials: T
authors.lastname: Pfiffer
authors.forename: Christhardt
authors.initials: C
authors.lastname: Köhler
authors.forename: Vanessa
authors.initials: V
authors.lastname: da Costa Miranda
authors.forename: Maria Del Pilar
authors.initials: Mdel P
authors.lastname: Estevez Diz
authors.forename: Julia Tizue
authors.initials: JT
authors.lastname: Fukushima
authors.forename: Edmund Chada
authors.initials: EC
authors.lastname: Baracat
authors.forename: Jesus Paula
authors.initials: JP
authors.lastname: Carvalho
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000601:surgery; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000009:adverse effects* / Q000401:mortality; D007813:Laparotomy; D007902:Length of Stay; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D017239:Paclitaxel / Q000008:administration & dosage; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D018401:Sample Size; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D016190:Carboplatin; D017239:Paclitaxel