Archives of Gynecology and Obstetrics

, Volume 297, Issue 5, pp 1255–1264 | Cite as

Report of the survey on current opinions and practice of German Society for Gynecologic Endoscopy (AGE) members regarding the laparoscopic treatment of ovarian malignancies

  • Julia Caroline Radosa
  • Marc Philipp Radosa
  • Pascal Albert Schweitzer
  • Ingolf Juhasz-Boess
  • Stefan Rimbach
  • Erich-Franz Solomayer
Gynecologic Oncology
  • 33 Downloads

Abstract

Purpose

The purpose of this survey was to assess the opinions of members of the German Society of Gynecologic Endoscopy (AGE) regarding the laparoscopic treatment of ovarian malignancies and current practice at their institutions.

Methods

Between February and October 2015, the AGE sent an anonymous online survey via mail to its members. The questionnaire solicited participants’ opinions about the laparoscopic treatment of ovarian cancers according to T stage and borderline tumors, and information about current practice at their institutions. Participants were also asked their opinions on currently available data on this issue.

Results

Of 228 AGE members who completed the survey, 132 (58%) were fellows or attending physicians and 156 (68%) worked at university hospitals or tertiary referral centers. Most [212 (93%)] respondents stated that < 10% of all ovarian cancer cases were currently treated laparoscopically at their institutions. Most participants indicated that T1 (a, b, c) tumors [145 (64%)] and ovarian borderline tumors [206 (90%)], but not T2 [48 (21%)] or T3/4 [9 (4%) ovarian tumors] should or could be treated laparoscopically. One hundred seventy-two (75%) participants considered currently available data on this topic to be insufficient and 152 (66%) stated that they would take part in a clinical trial assessing a laparoscopic approach to T1/2 ovarian cancer.

Conclusion

According to this survey, to the opinion of the majority of AGE members, laparoscopy might be a considerable option for the treatment of early ovarian malignancies and borderline tumors and should be evaluated further in future studies.

Keywords

Gynecologic endoscopy Minimally invasive surgery Laparoscopy Ovarian cancer AGE Borderline ovarian tumor 

Notes

Author contributions

JCR: project development, data collection, manuscript writing. PAS: data management, data analysis. MPR: project development, data analysis. IJ-B: data management. SR: manuscript editing. EFS: project development, manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with patients or animals performed by any of the authors.

Informed consent

Informed consent was given from all individual participants included in the study by responding to the questionnaire.

Supplementary material

404_2018_4709_MOESM1_ESM.doc (92 kb)
Supplementary material 1 (DOC 91 kb)

References

  1. 1.
    Bristow RE, Tomacruz RS, Armstrong DK, Trimble EL, Montz FJ (2002) Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol Off J Am Soc Clin Oncol 20(5):1248–1259 (PubMed PMID: 11870167. Epub 2002/03/01.eng) CrossRefGoogle Scholar
  2. 2.
    Elattar A, Bryant A, Winter-Roach BA, Hatem M, Naik R (2011) Optimal primary surgical treatment for advanced epithelial ovarian cancer. Cochrane Database Syst Rev (8):CD007565.  https://doi.org/10.1002/14651858.CD007565.pub2
  3. 3.
    Cho JE, Liu C, Gossner G, Nezhat FR (2009) Laparoscopy and gynecologic oncology. Clin Obstet Gynecol 52(3):313–326 (PubMed PMID: 19661747. Epub 2009/08/08.eng) CrossRefPubMedGoogle Scholar
  4. 4.
    Jernigan AM, Auer M, Fader AN, Escobar PF (2012) Minimally invasive surgery in gynecologic oncology: a review of modalities and the literature. Womens Health (London, England) 8(3):239–250 (PubMed PMID: 22554172. Epub 2012/05/05.eng) CrossRefGoogle Scholar
  5. 5.
    Rimbach S, Neis K, Solomayer E, Ulrich U, Wallwiener D (2014) Current and future status of laparoscopy in gynecologic oncology. Geburtshilfe und Frauenheilkunde 74(9):852–859 (PubMed PMID: 25278627. Pubmed Central PMCID: PMC4175127. Epub 2014/10/04.Eng) CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Park HJ, Kim DW, Yim GW, Nam EJ, Kim S, Kim YT (2013) Staging laparoscopy for the management of early-stage ovarian cancer: a metaanalysis. Am J Obstet Gynecol 209(1):58e1-8 (PubMed PMID: 23583213. Epub 2013/04/16.eng) CrossRefGoogle Scholar
  7. 7.
    Sjovall K, Nilsson B, Einhorn N (1994) Different types of rupture of the tumor capsule and the impact on survival in early ovarian carcinoma. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 4(5):333–336 (PubMed PMID: 11578428. Epub 1994/09/01.Eng) CrossRefGoogle Scholar
  8. 8.
    Zivanovic O, Sonoda Y, Diaz JP, Levine DA, Brown CL, Chi DS et al (2008) The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease. Gynecol Oncol 111(3):431–437 (PubMed PMID: 18929404) CrossRefPubMedGoogle Scholar
  9. 9.
    Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Diagnostik, Therapie und Nachsorge maligner Ovarialtumoren, Kurzversion 2.0, 2016, AWMF-Registrierungsnummer: 032-035OL. http://leitlinienprogramm-onkologie.de/Ovarialkarzinom.61.0.html. Accessed 11 Aug 2017
  10. 10.
    Fagotti A, Fanfani F, Vizzielli G, Gallotta V, Ercoli A, Paglia A et al (2010) Should laparoscopy be included in the work-up of advanced ovarian cancer patients attempting interval debulking surgery? Gynecol Oncol 116(1):72–77 (PubMed PMID: 19846211. Epub 2009/10/23.eng) CrossRefPubMedGoogle Scholar
  11. 11.
    Fagotti A, Perelli F, Pedone L, Scambia G (2016) Current recommendations for minimally invasive surgical staging in ovarian cancer. Curr Treat Options Oncol 7(1):3 (PubMed PMID: 26739150. Epub 2016/01/08.eng) CrossRefGoogle Scholar
  12. 12.
    Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT et al (2008) Comparison of laparoscopy and laparotomy in surgical staging of early-stage ovarian and fallopian tubal cancer. Ann Surg Oncol 15(7):2012–2019 (PubMed PMID: 18437497. Epub 2008/04/26.eng) CrossRefPubMedGoogle Scholar
  13. 13.
    Conrad LB, Ramirez PT, Burke W, Naumann RW, Ring KL, Munsell MF et al (2015) Role of minimally invasive surgery in gynecologic oncology: an updated survey of members of the society of gynecologic oncology. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 25(6):1121–1127 (PubMed PMID: 25860841. Pubmed Central PMCID: PMC4478101. Epub 2015/04/11.eng) CrossRefGoogle Scholar
  14. 14.
    Schmalfeldt B, du Bois A, Burges A, Emons G, Fink D, Gropp M et al (2006) Diagnosis and treatment of malignant ovarian tumors 2005: recommendations of the Kommission Ovar of the AGO. Zentralblatt fur Gynakologie 128(1):11–17 (PubMed PMID: 16450281. Epub 2006/02/02. Diagnostik und Therapie maligner Ovarialtumoren 2005: Die Empfehlungen der Kommission Ovar der AGO.ger) CrossRefPubMedGoogle Scholar
  15. 15.
    Bogani G, Cromi A, Serati M, Di Naro E, Casarin J, Pinelli C et al (2014) Laparoscopic and open abdominal staging for early-stage ovarian cancer: our experience, systematic review, and meta-analysis of comparative studies. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 24(7):1241–1249 (PubMed PMID: 25054448. Epub 2014/07/24.eng) CrossRefGoogle Scholar
  16. 16.
    Morgan RJ Jr, Alvarez RD, Armstrong DK, Burger RA, Chen LM, Copeland L et al (2013) Ovarian cancer, version 2.2013. J Natl Compr Cancer Netw JNCCN 11(10):1199–1209 (PubMed PMID: 24142821. Epub 2013/10/22.eng) CrossRefGoogle Scholar
  17. 17.
    Lawrie TA, Medeiros LR, Rosa DD, da Rosa MI, Edelweiss MI, Stein AT, Zelmanowicz A, Ethur AB, Zanini RR (2013) Laparoscopy versus laparotomy for FIGO stage I ovarian cancer. Cochrane Database Syst Rev (2):CD005344.  https://doi.org/10.1002/14651858.CD005344.pub3
  18. 18.
    Fagotti A, Ferrandina G, Fanfani F, Ercoli A, Lorusso D, Rossi M et al (2006) A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol 13(8):1156–1161 (PubMed PMID: 16791447. Epub 2006/06/23.eng) CrossRefPubMedGoogle Scholar
  19. 19.
    Rutten MJ, Leeflang MM, Kenter GG, Mol BW, Buist M (2014) Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer. Cochrane Database Syst Rev (2):CD009786 (PubMed PMID: 24563459. Epub 2014/02/25.eng)Google Scholar
  20. 20.
    Corrado G, Mancini E, Cutillo G, Baiocco E, Vici P, Sergi D et al (2015) Laparoscopic debulking surgery in the management of advanced ovarian cancer after neoadjuvant chemotherapy. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 25(7):1253–1257 (PubMed PMID: 26111273. Epub 2015/06/26.eng) CrossRefGoogle Scholar
  21. 21.
    Nezhat FR, DeNoble SM, Liu CS, Cho JE, Brown DN, Chuang L et al (2010) The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian, fallopian tube, and primary peritoneal cancers. JSLS J Soc Laparoendosc Surg Soc Laparoendosc Surg 14(2):155–168 (PubMed PMID: 20932362. Pubmed Central PMCID: PMC3043561. Epub 2010/10/12.eng) CrossRefGoogle Scholar
  22. 22.
    Fanning J, Yacoub E, Hojat R (2011) Laparoscopic-assisted cytoreduction for primary advanced ovarian cancer: success, morbidity and survival. Gynecol Oncol 123(1):47–49 (PubMed PMID: 21741079. Epub 2011/07/12.eng) CrossRefPubMedGoogle Scholar
  23. 23.
    Alletti SG, Bottoni C, Fanfani F, Gallotta V, Chiantera V, Costantini B et al (2016) Minimally invasive interval debulking surgery in ovarian neoplasm (MISSION trial-NCT02324595): a feasibility study. Am J Obstet Gynecol 214(4):503e1-6 (PubMed PMID: 26529370. Epub 2015/11/04.eng) Google Scholar
  24. 24.
    Ghezzi F, Cromi A, Uccella S, Bergamini V, Tomera S, Franchi M et al (2007) Laparoscopy versus laparotomy for the surgical management of apparent early stage ovarian cancer. Gynecol Oncol 105(2):409–413 (PubMed PMID: 17275077. Epub 2007/02/06.eng) CrossRefPubMedGoogle Scholar
  25. 25.
    Chi DS, Abu-Rustum NR, Sonoda Y, Ivy J, Rhee E, Moore K et al (2005) The safety and efficacy of laparoscopic surgical staging of apparent stage I ovarian and fallopian tube cancers. Am J Obstet Gynecol 192(5):1614–1619 (PubMed PMID: 15902166. Epub 2005/05/20.eng) CrossRefPubMedGoogle Scholar
  26. 26.
    Nezhat FR, Ezzati M, Chuang L, Shamshirsaz AA, Rahaman J, Gretz H (2009) Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome. Am J Obstet Gynecol 200(1):83e1-6 (PubMed PMID: 19019337. Epub 2008/11/21.eng) CrossRefGoogle Scholar
  27. 27.
    Canis M, Rabischong B, Botchorishvili R, Tamburro S, Wattiez A, Mage G et al (2001) Risk of spread of ovarian cancer after laparoscopic surgery. Curr Opin Obstet Gynecol 13(1):9–14 (PubMed PMID: 11176227. Epub 2001/02/15.eng) CrossRefPubMedGoogle Scholar
  28. 28.
    Leminen A, Lehtovirta P (1999) Spread of ovarian cancer after laparoscopic surgery: report of eight cases. Gynecol Oncol 75(3):387–390 (PubMed PMID: 10600294. Epub 1999/12/22.eng) CrossRefPubMedGoogle Scholar
  29. 29.
    Pomel C, Provencher D, Dauplat J, Gauthier P, Le Bouedec G, Drouin P et al (1995) Laparoscopic staging of early ovarian cancer. Gynecol Oncol 58(3):301–306 (PubMed PMID: 7672696. Epub 1995/09/01.eng) CrossRefPubMedGoogle Scholar
  30. 30.
    Canis M, Botchorishvili R, Manhes H, Wattiez A, Mage G, Pouly JL et al (2000) Management of adnexal masses: role and risk of laparoscopy. Semin Surgical Oncol 19(1):28–35 (PubMed PMID: 10883021) CrossRefGoogle Scholar
  31. 31.
    Park JY, Bae J, Lim MC, Lim SY, Seo SS, Kang S et al (2008) Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 18(6):1202–1209 (PubMed PMID: 18284455. Epub 2008/02/21.eng) CrossRefGoogle Scholar
  32. 32.
    de la Cuesta Sainz R, Goff BA, Fuller AF Jr, Nikrui N, Eichhorn JH, Rice LW (1994) Prognostic importance of intraoperative rupture of malignant ovarian epithelial neoplasms. Obstet Gynecol 84(1):1–7 (PubMed PMID: 8008300) Google Scholar
  33. 33.
    Bakkum-Gamez JN, Richardson DL, Seamon LG, Aletti GD, Powless CA, Keeney GL et al (2009) Influence of intraoperative capsule rupture on outcomes in stage I epithelial ovarian cancer. Obstet Gynecol 113(1):11–17 (PubMed PMID: 19104354. Epub 2008/12/24.eng) CrossRefPubMedGoogle Scholar
  34. 34.
    Kim HS, Ahn JH, Chung HH, Kim JW, Park NH, Song YS et al (2013) Impact of intraoperative rupture of the ovarian capsule on prognosis in patients with early-stage epithelial ovarian cancer: a meta-analysis. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol 39(3):279–289 (PubMed PMID: 23273873. Epub 2013/01/01.eng) Google Scholar
  35. 35.
    Wildbrett P, Oh A, Naundorf D, Volk T, Jacobi CA (2003) Impact of laparoscopic gases on peritoneal microenvironment and essential parameters of cell function. Surg Endosc 17(1):78–82 (PubMed PMID: 12360379. Epub 2002/10/03.eng) CrossRefPubMedGoogle Scholar
  36. 36.
    Smidt VJ, Singh DM, Hurteau JA, Hurd WW (2001) Effect of carbon dioxide on human ovarian carcinoma cell growth. Am J Obstet Gynecol 185(6):1314–1317 (PubMed PMID: 11744902. Epub 2001/12/18.eng) CrossRefPubMedGoogle Scholar
  37. 37.
    Lee M, Kim SW, Paek J, Lee SH, Yim GW, Kim JH et al (2011) Comparisons of surgical outcomes, complications, and costs between laparotomy and laparoscopy in early-stage ovarian cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 21(2):251–256 (PubMed PMID: 21270608. Epub 2011/01/29.eng) CrossRefGoogle Scholar
  38. 38.
    Ghezzi F, Malzoni M, Vizza E, Cromi A, Perone C, Corrado G et al (2012) Laparoscopic staging of early ovarian cancer: results of a multi-institutional cohort study. Ann Surg Oncol 19(5):1589–1594 (PubMed PMID: 22086443. Epub 2011/11/17.eng) CrossRefPubMedGoogle Scholar
  39. 39.
    Possover M, Krause N, Plaul K, Kuhne-Heid R, Schneider A (1998) Laparoscopic para-aortic and pelvic lymphadenectomy: experience with 150 patients and review of the literature. Gynecol Oncol 71(1):19–28 (PubMed PMID: 9784314. Epub 1998/10/24.eng) CrossRefPubMedGoogle Scholar
  40. 40.
    Ramirez PT, Wolf JK, Levenback C (2003) Laparoscopic port-site metastases: etiology and prevention. Gynecol Oncol 91(1):179–189 (PubMed PMID: 14529679) CrossRefPubMedGoogle Scholar
  41. 41.
    van Dam PA, DeCloedt J, Tjalma WA, Buytaert P, Becquart D, Vergote IB (1999) Trocar implantation metastasis after laparoscopy in patients with advanced ovarian cancer: can the risk be reduced? Am J Obstet Gynecol 181(3):536–541 (PubMed PMID: 10486460. Epub 1999/09/16.eng) CrossRefPubMedGoogle Scholar
  42. 42.
    Kruitwagen RF, Swinkels BM, Keyser KG, Doesburg WH, Schijf CP (1996) Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer. Gynecol Oncol 60(2):233–237 (PubMed PMID: 8631544. Epub 1996/02/01.eng) CrossRefPubMedGoogle Scholar
  43. 43.
    Vergote I, Marquette S, Amant F, Berteloot P, Neven P (2005) Port-site metastases after open laparoscopy: a study in 173 patients with advanced ovarian carcinoma. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 15(5):776–779 (PubMed PMID: 16174223. Epub 2005/09/22.eng) CrossRefGoogle Scholar
  44. 44.
    Ataseven B, Grimm C, Harter P, Heikaus S, Heitz F, Traut A et al (2016) Prognostic impact of port-site metastasis after diagnostic laparoscopy for epithelial ovarian cancer. Ann Surg Oncol 23(Suppl 5):834–840 (PubMed PMID: 27406097. Epub 2016/07/14.eng) CrossRefPubMedGoogle Scholar
  45. 45.
    Fischerova D, Zikan M, Dundr P, Cibula D (2012) Diagnosis, treatment, and follow-up of borderline ovarian tumors. Oncologist 17(12):1515–1533 (PubMed PMID: 23024155. Pubmed Central PMCID: PMC3528384. Epub 2012/10/02.eng) CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Fauvet R, Boccara J, Dufournet C, Poncelet C, Darai E (2005) Laparoscopic management of borderline ovarian tumors: results of a French multicenter study. Ann Oncol Off J Eur Soc Med Oncol ESMO 16(3):403–410 (PubMed PMID: 15653700. Epub 2005/01/18.eng) CrossRefGoogle Scholar
  47. 47.
    Maneo A, Vignali M, Chiari S, Colombo A, Mangioni C, Landoni F (2004) Are borderline tumors of the ovary safely treated by laparoscopy? Gynecol Oncol 94(2):387–392 (PubMed PMID: 15297177. Epub 2004/08/07.eng) CrossRefPubMedGoogle Scholar
  48. 48.
    Odegaard E, Staff AC, Langebrekke A, Engh V, Onsrud M (2007) Surgery of borderline tumors of the ovary: retrospective comparison of short-term outcome after laparoscopy or laparotomy. Acta obstetricia et gynecologica Scandinavica 86(5):620–626 (PubMed PMID: 17464594. Epub 2007/04/28.eng) CrossRefPubMedGoogle Scholar
  49. 49.
    Romagnolo C, Gadducci A, Sartori E, Zola P, Maggino T (2006) Management of borderline ovarian tumors: results of an Italian multicenter study. Gynecol Oncol 101(2):255–260 (PubMed PMID: 16307793. Epub 2005/11/26.eng) CrossRefPubMedGoogle Scholar
  50. 50.
    Harter P, Gershenson D, Lhomme C, Lecuru F, Ledermann J, Provencher DM et al (2014) Gynecologic Cancer InterGroup (GCIG) consensus review for ovarian tumors of low malignant potential (borderline ovarian tumors). Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 24(9 Suppl 3):S5–S8 (PubMed PMID: 25341581. Epub 2014/10/25.eng) CrossRefGoogle Scholar
  51. 51.
    Reinisch JF, Yu DC, Li WY (2016) Getting a valid survey response from 662 plastic surgeons in the 21st century. Ann Plast Surg 76(1):3–5 (PubMed PMID: 26418779. Epub 2015/09/30.eng) CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gynecology and ObstetricsSaarland University HospitalHomburgGermany
  2. 2.Department of GynecologyAgaplesion Diakonie Hospital KasselKasselGermany
  3. 3.Department of Gynecology and ObstetricsAgatharied HospitalHaushamGermany

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