Robotic surgery for ovarian cancers: individualization of the surgical approach to select ovarian cancer patients

A novel laparoscopy-based model for the prediction of optimal cytoreduction and prognosis of epithelial ovarian cancer in a Chinese population

OBJECTIVES

This study aimed to investigate the predictive value of laparoscopy for the prediction of optimal cytoreduction and prognosis of epithelial ovarian cancer (EOC) in a Chinese population.

STUDY DESIGN

This study enrolled 162 EOC patients in Obstetrics and Gynecology Hospital of Fudan University from January 2015 to December 2016. All patients underwent preoperative CT scans and laparoscopic assessments. Each patient was scored according to the CT-based predictive model by Bristow and laparoscopy-based predictive model by Fagotti. The specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and area under the curve (AUC) of each model were calculated. The predictive scores and clinicopathologic factors were all analyzed using the Kaplan-Meier method and multivariate Cox analysis. A prognostic predictive nomogram was formulated in R software.

RESULTS

The AUCs of the laparoscopy-based predictive model and CT-based predictive model was 0.955 and 0.755 respectively. At a laparoscopic score ≥ 10, the possibility of optimal cytoreduction was 0, and the risk of unnecessary explorative attempts was 6%. Additionally, laparoscopic score, independent of residual tumor size and FIGO stage, was an independent prognostic factor for both overall survival (OS) and recurrence-free survival (RFS) in EOC. Notably, the predictive nomogram that we established further confirmed the prognostic value of laparoscopy for prognostic predictions in EOC.

CONCLUSIONS

Laparoscopy has a better discriminating performance than CT in the prediction of optimal cytoreduction in EOC. Moreover, the laparoscopic score is directly correlated with the survival of EOC patients. The laparoscopic score-based nomogram we established showed good potential to predict the prognosis of EOC patients.

Current Recommendations for Minimally Invasive Surgical Staging in Ovarian Cancer

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.

Comparison of conventional laparoscopy and robotic radical hysterectomy for early-stage cervical cancer: A meta-analysis

BACKGROUND

Cervical cancer continues to be a global burden for women, with >500,000 cases and 275,000 deaths reported annually. Resources-rich countries have seen a dramatic reduction in the prevalence of invasive cervical cancer due to widely accessed radical hysterectomy (RH). We aimed to compare initial surgical outcomes and complication rates of conventional laparoscopic RH (LRH) and robotic RH (RRH) for treating cervical cancer through a systematic meta-analysis.

METHODS

PubMed, EMBASE, and the Cochrane Library databases were systematically searched for all relevant studies. Data were abstracted independently. A meta-analysis was performed to compare intra- and post-operative outcomes for the two techniques.

RESULTS

A total of 12 clinical trials were identified. Meta-analysis showed that although LRH and RRH were similar in terms of operating time, the length of hospital stay, and a number of pelvic lymph nodes resected, RRH presented less blood loss and overwhelming advantage against LRH with the respect of complications.

CONCLUSION

RRH may be a reliable technique for treating early cervical cancer. Available evidence suggests that it is better than LRH for postoperative recovery, while the two techniques involve similar surgical outcomes and share the same limits in clinical practice.