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Current Recommendations for Minimally Invasive Surgical Staging in Ovarian Cancer

  • Gynecologic Cancers (RJ Morgan, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Minimally invasive surgery (MIS) currently is performed to stage and treat ovarian cancer at different stages of disease; however, the higher level of evidence from existing studies is IIB. Despite the absence of randomized controlled trials, MIS represents a safe and adequate procedure for treating and staging early ovarian cancer, and its use has increased significantly in clinical practice. Major concerns are related to minimizing tumor disruption or dissemination, removing the adnexal mass intact, adequate retroperitoneal staging, and fertility-sparing surgery for young patients. The main goal for patients with advanced ovarian cancer is to determine the best therapeutic strategy by evaluating the risks and benefits of primary debulking surgery versus neoadjuvant chemotherapy followed by interval debulking surgery. The use of staging laparoscopy in patients with advanced epithelial ovarian cancer appears to be the most researched and accepted approach. Regarding other types and stages of ovarian cancer, although the evidence is very promising, clinical trials performed by expert gynecologic oncology surgeons in referral centers are still needed to prove the efficacy of such an approach in these patients. In particular, MIS has provided an opportunity to remove localized recurrences, with both retroperitoneal and intraperitoneal diffusion.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.

    Article  PubMed  Google Scholar 

  2. NCCN Clinical Practice Guidelines in Oncology. Ovarian cancer including fallopian tube cancer and primary peritoneal cancer Version I. 2015.

  3. Nezhat C, Nezhat F, Teng NN, et al. The role of laparoscopy in the management of gynecologic malignancy. Semin Surg Oncol. 1994;10(6):431–9.

    Article  PubMed  CAS  Google Scholar 

  4. Conrad LB, Ramirez PT, Burke W, et al. Role of minimally invasive surgery in gynecologic oncology: an updated survey of members of the society of gynecologic oncology. Int J Gynecol Cancer. 2015;25(6):1121–7.

    Article  PubMed  Google Scholar 

  5. Ahmad G, O’Flynn H, Duffy JM, Phillips K, Watson A. Laparoscopic entry techniques. Cochrane Database Syst Rev. 2012;2, CD006583.

    PubMed  Google Scholar 

  6. Pryor A, Mann WJ, Gracia G, Marks J, Falcone T, Chen W. Complications of laparoscopic surgery. UpToDate. 2013.

  7. Rabinovich A. Robotic surgery for ovarian cancers: individualization of the surgical approach to select ovarian cancer patients. Int J Med Robot. 2015. doi:10.1002/rcs.1684.

    PubMed  Google Scholar 

  8. Gabay M, Boucher BA. An essential primer for understanding the role of topical hemostats, surgical sealants, and adhesives for maintaining hemostasis. Pharmacotherapy. 2013;33(9):935–55.

    Article  PubMed  Google Scholar 

  9. Lin CJ, Chen HJ. The investigation of laparoscopic instrument movement control and learning effect. Biomed Res Int. 2013;2013:349825.

    PubMed  PubMed Central  Google Scholar 

  10. Abu-Rustum NR, Rhee EH, Chi DS, Sonoda Y, Gemignani M, Barakat RR. Subcutaneous tumor implantation after laparoscopic procedures in women with malignant disease. Obstet Gynecol. 2004;103(3):480–7.

    Article  PubMed  Google Scholar 

  11. Agostini A, Mattei S, Ronda I, Banet J, Lécuru F, Blanc B. Prevention of port-site metastasis after laparoscopy. Gynecol Obstet Fertil. 2002;30(11):878–81. Review.

    Article  PubMed  CAS  Google Scholar 

  12. Vergote I, Marquette S, Amant F, Berteloot P, Neven P. Port-site metastases after open laparoscopy: a study in 173 patients with advanced ovarian carcinoma. Int J Gynecol Cancer. 2005;15(5):776–9.

    Article  PubMed  CAS  Google Scholar 

  13. Lawrie TA, Medeiros LR, Rosa DD, et al. Laparoscopy versus laparotomy for FIGO stage I ovarian cancer. Cochrane Database Syst Rev. 2013;2, CD005344. Review.

    PubMed  Google Scholar 

  14. Gallotta V, Ghezzi F, Vizza E, et al. Laparoscopic staging of apparent early stage ovarian cancer: results of a large, retrospective, multi-institutional series. Gynecol Oncol. 2014;135(3):428–34. Multi-institutional study with the largest series in the literature. It shows feasibility and safety of MIS with respect to open surgery.

    Article  PubMed  CAS  Google Scholar 

  15. Tozzi R, Köhler C, Ferrara A, Schneider A. Laparoscopic treatment of early ovarian cancer: surgical and survival outcomes. Gynecol Oncol. 2004;93(1):199–203.

    Article  PubMed  Google Scholar 

  16. Ghezzi F, Cromi A, Uccella S, et al. Laparoscopy versus laparotomy for the surgical management of apparent early stage ovarian cancer. Gynecol Oncol. 2007;105(2):409–13.

    Article  PubMed  Google Scholar 

  17. Nezhat FR, Ezzati M, Chuang L, Shamshirsaz AA, Rahaman J, Gretz H. Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome. Am J Obstet Gynecol. 2009;200(1):83.e1–6.

    Article  Google Scholar 

  18. Lee M, Kim SW, Paek J, et al. Comparisons of surgical outcomes, complications, and costs between laparotomy and laparoscopy in early-stage ovarian cancer. Int J Gynecol Cancer. 2011;21(2):251–6.

    Article  PubMed  Google Scholar 

  19. Cress RD, Bauer K, O’Malley CD, et al. Surgical staging of early stage epithelial ovarian cancer: results from the CDC-NPCR ovarian patterns of care study. Gynecol Oncol. 2011;121(1):94–9.

    Article  PubMed  Google Scholar 

  20. Brockbank EC, Harry V, Kolomainen D, et al. Laparoscopic staging for apparent early stage ovarian or fallopian tube cancer. First case series from a UK cancer centre and systematic literature review. Eur J Surg Oncol. 2013;39(8):912–7.

    Article  PubMed  CAS  Google Scholar 

  21. Petrillo M, Vizzielli G, Fanfani F, et al. Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: proof of a concept. Gynecol Oncol. 2015. doi:10.1016/j.ygyno.2015.07.095.

    Google Scholar 

  22. Fagotti A, Vizzielli G, Fanfani F, et al. Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience. Gynecol Oncol. 2013;131:341–6.

    Article  PubMed  CAS  Google Scholar 

  23. Vizzielli G, Costantini B, Tortorella L, et al. Influence of Intraperitoneal dissemination assessed by laparoscopy on prognosis of AOC: an exploratory analysis of a single-institution experience. Ann Surg Oncol. 2014;21:3970–7.

    Article  PubMed  Google Scholar 

  24. Nezhat FR, DeNoble SM, Liu CS, et al. The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian, fallopian tube, and primary peritoneal cancers. JSLS. 2010;14(2):155–68.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Fanning J, Yacoub E, Hojat R. Laparoscopic-assisted cytoreduction for primary advanced ovarian cancer: success, morbidity and survival. Gynecol Oncol. 2011;123(1):47–9.

    Article  PubMed  Google Scholar 

  26. Sinno AK, Fader AN. Robotic-assisted surgery in gynecologic oncology. Fertil Steril. 2014;102(4):922–3. Review.

    Article  PubMed  Google Scholar 

  27. Favero G, Macerox N, Pfiffer T, et al. Oncologic concerns regarding laparoscopic cytoreductive surgery in patients with advanced ovarian cancer submitted to neoadjuvant chemotherapy. Oncology. 2015;89(3):159–66.

    Article  PubMed  CAS  Google Scholar 

  28. Corrado G, Mancini E, Cutillo G, et al. Laparoscopic debulking surgery in the management of advanced ovarian cancer after neoadjuvant chemotherapy. Int J Gynecol Cancer. 2015;25(7):1253–7.

    Article  PubMed  Google Scholar 

  29. Gueli Alletti S, Bottoni C, Fanfani F, et al. Minimally Invasive Interval debulking Surgery in Ovarian Neoplasm (Mission trial - NCT02324595): a feasibility study. AJOG, submitted.

  30. Fagotti A, Ferrandina G, Fanfani F, et al. Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma. Am J Obstet Gynecol. 2008;199:642.e1–6.

    Article  Google Scholar 

  31. Fanfani F, Monterossi G, Fagotti A, et al. Positron emission tomography-laparoscopy based method in the prediction of complete cytoreduction in platinum-sensitive recurrent ovarian cancer. Ann Surg Oncol. 2015;22(2):649–54.

    Article  PubMed  Google Scholar 

  32. Passot G, Bakrin N, Isaac S, et al. Postoperative outcomes of laparoscopic vs open cytoreductive surgery plus hyperthermic Intraperitoneal chemotherapy for treatment of peritoneal surface malignancies. Eur J Surg Oncol. 2014;40(8):957–62.

    Article  PubMed  CAS  Google Scholar 

  33. Fish R, Selvasekar C, Crichton P, et al. Risk-reducing laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for low-gradeappendiceal mucinous neoplasm: early outcomes and technique. Surg Endosc. 2014;28(1):341–5.

  34. Gallotta V, Fagotti A, Fanfani F, et al. Laparoscopic surgical management of localized recurrent ovarian cancer: a single-institution experience. Surg Endosc. 2014;28(6):1808–15.

    Article  PubMed  Google Scholar 

  35. Fagotti A, Petrillo M, Costantini B, et al. Minimally invasive secondary cytoreduction plus HIPEC for recurrent ovarian cancer: a case series. Gynecol Oncol. 2014;132(2):303–6.

    Article  PubMed  CAS  Google Scholar 

  36. Fagotti A, Costantini B, Gallotta V, et al. Minimally invasive secondary cytoreduction plus HIPEC versus open surgery plus HIPEC in isolated relapse from ovarian cancer: a retrospective cohort study on perioperative outcomes. J Minim Invasive Gynecol. 2015;22(3):428–32.

    Article  PubMed  Google Scholar 

  37. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.

    Article  PubMed  Google Scholar 

  38. Vergote I, De Brabanter J, Fyles A, et al. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet. 2001;357(9251):176–82.

    Article  PubMed  CAS  Google Scholar 

  39. Park HJ, Kim DW, Yim GW, Nam EJ, Kim S, Kim YT. Staging laparoscopy for the management of early-stage ovarian cancer: a metaanalysis. Am J Obstet Gynecol. 2013;209(1):58.e1–8.

    Article  Google Scholar 

  40. Muto MG, Sharp HT, Goff B, Falk SJ. Management of an adnexal mass. UpToDate. 2014.

  41. Fruscio R, Corso S, Ceppi L, et al. Conservative management of early-stage epithelial ovarian cancer: results of a large retrospective series. Ann Oncol. 2013;24(1):138–44.

    Article  PubMed  CAS  Google Scholar 

  42. Zapardiel I, Diestro MD, Aletti G. Conservative treatment of early stage ovarian cancer: oncological and fertility outcomes. Eur J Surg Oncol. 2014;40(4):387–93.

    Article  PubMed  CAS  Google Scholar 

  43. Vergote I, DeWever I, Tjalma W, Van Gramberen M, Decloedt J, van Dam P. Neoadjuvant chemotherapy or primary debulking surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients. Gynecol Oncol. 1998;71:431–6.

    Article  PubMed  CAS  Google Scholar 

  44. Angioli R, Palaia I, Zullo MA, et al. Diagnostic open laparoscopy in the management of advanced ovarian cancer. Gynecol Oncol. 2006;100(3):455–61.

    Article  PubMed  Google Scholar 

  45. Fagotti A, Fanfani F, Ludovisi M, et al. Role of laparoscopy to assess the chance of optimal cytoreductive surgery in advanced ovarian cancer: a pilot study. Gynecol Oncol. 2005;96:729–35.

    Article  PubMed  Google Scholar 

  46. Fagotti A, Ferrandina G, Fanfani F, et al. A laparoscopy based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol. 2006;13:1156–61.

    Article  PubMed  Google Scholar 

  47. Brun JL, Rouzier R, Uzan S, Darai E. External validation of a laparoscopic-based score to evaluate resectability of advanced ovarian cancers: clues for a simplified score. Gynecol Oncol. 2008;110:354–9.

    Article  PubMed  Google Scholar 

  48. Fagotti A, Vizzielli G, De Iaco P, et al. A multicentric trial [olympia-MITO13] on the accuracy of laparoscopy to assess peritoneal spread in ovarian cancer. Am J Obstet Gynecol. 2013;209:462.e1–11. Multicentric prospective trial on reliability and reproducibility of a simple scoring system by laparoscopy to assess the chance of optimal cytoreduction.

    Article  Google Scholar 

  49. Rutten MJ, Leeflang MM, Kenter GG, Mol BW, Buist M. Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer. Cochrane Database Syst Rev. 2014;21:2. Review.

    Google Scholar 

  50. Rutten MJ, Gaarenstroom KN, Van Gorp T, et al. Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study. BMC Cancer. 2012;12:31.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Surgical Complications Related to Primary or Interval Debulking in Ovarian Neoplasm (SCORPION trial - NCT01461850).

  52. Fagotti A, Fanfani F, Vizzielli G, et al. Should laparoscopy be included in the work-up of advanced ovarian cancer patients attempting interval debulking surgery? Gynecol Oncol. 2010;116(1):72–7.

    Article  PubMed  CAS  Google Scholar 

  53. Chereau E, Lavoue V, Ballester M, et al. External validation of a laparoscopic-based score to evaluate resectability for patients with advanced ovarian cancer undergoing interval debulking surgery. Anticancer Res. 2011;31(12):4469–74.

    PubMed  CAS  Google Scholar 

  54. Bristow RE, Puri I, Chi DS. Cytoreductive surgery for recurrent ovarian cancer: a meta-analysis. Gynecol Oncol. 2009;112(1):265–74. Review.

    Article  PubMed  Google Scholar 

  55. Fagotti A, Fanfani F, Rossitto C, et al. A treatment selection protocol for recurrent ovarian cancer patients: the role of FDG-PET/CT and staging laparoscopy. Oncology. 2008;75(3–4):152–8.

    Article  PubMed  CAS  Google Scholar 

  56. Harter P, Sehouli J, Reuss A, et al. Prospective validation study of a predictive score for operability of recurrent ovarian cancer: the multicenter intergroup study DESKTOP II. A project of the AGO Kommission OVAR, AGO study group, NOGGO, AGO-Austria, and MITO. Int J Gynecol Cancer. 2011;21(2):289–95.

    Article  PubMed  Google Scholar 

  57. Nezhat FR, Denoble SM, Cho JE, et al. Safety and efficacy of video laparoscopic surgical debulking of recurrent ovarian, fallopian tube, and primary peritoneal cancers. JSLS. 2012;16(4):511–8.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Magrina JF, Cetta RL, Chang YH, Guevara G, Magtibay PM. Analysis of secondary cytoreduction for recurrent ovarian cancer by robotics, laparoscopy and laparotomy. Gynecol Oncol. 2013;129(2):336–40.

    Article  PubMed  Google Scholar 

  59. Escobar PF, Levinson KL, Magrina J, et al. Feasibility and perioperative outcomes of robotic-assisted surgery in the management of recurrent ovarian cancer: a multi-institutional study. Gynecol Oncol. 2014;134(2):253–6. The largest series in literature describing surgical and postoperative benefits of MIS for recurrent ovarian cancer compared to open approach.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Gynecologic Oncology, S. Maria Hospital, University of Perugia, Terni, Italy

    Anna Fagotti MD, PhD

  2. Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy

    Federica Perelli MD

  3. Obstetrics and Gynecology, Policlinico Gemelli, Catholic University of the Sacred Heart, Rome, Italy

    Luigi Pedone MD & Giovanni Scambia MD

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  1. Anna Fagotti MD, PhD
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  2. Federica Perelli MD
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  3. Luigi Pedone MD
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  4. Giovanni Scambia MD
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Correspondence to Anna Fagotti MD, PhD.

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Anna Fagotti, Federica Perelli, Luigi Pedone, and Giovanni Scambia declare that they have no conflict of interest.

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This article is part of the Topical Collection on Gynecologic Cancers

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Fagotti, A., Perelli, F., Pedone, L. et al. Current Recommendations for Minimally Invasive Surgical Staging in Ovarian Cancer. Curr. Treat. Options in Oncol. 17, 3 (2016). https://doi.org/10.1007/s11864-015-0379-8

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