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Costales AB, Crane EK, Chambers L, Yao M, Chau D, Naumann WR, Debernardo R, Ricci S, Rose PG, Michener CM. Laparoscopic predictability of minimally invasive interval debulking in advanced ovarian cancer: The MIID-SOC trial. Gynecol Oncol 2024; 185:143-147. [PMID: 38417209 DOI: 10.1016/j.ygyno.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND We sought to create a laparoscopic-based model to predict the ability to perform a minimally invasive (MIS) cytoreductive surgery in advanced epithelial ovarian cancer patients who have received neoadjuvant chemotherapy (NACT). METHODS Fifty women were enrolled in a multi-institutional prospective pilot study (NCT03378128). Each patient underwent laparoscopic evaluation of 43 abdominopelvic sites followed by surgeon dictated surgical approach, either continue MIS or laparotomically. However, if the procedure continued MIS, the placement of a hand-assist port for manual palpation was mandated to emulate a laparotomic approach and all 43 sites were re-evaluated. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated for each site to predict MIS resectability. Each parameter was assigned a numeric value based on the strength of statistical association and a total predictive index score (PIV) was assigned for each patient. Receiver operating characteristic curve analysis was used to assess the ability of the model to predict the MIS approach. RESULTS Twenty-seven patients (61%) underwent MIS surgery. The following abdominopelvic sites were selected for inclusion in the model: gastrosplenic ligament, rectum, left mesocolon, transverse colon, right colon, cecum, appendix, liver capsule, intrahepatic fossa/gallbladder, ileum/jejunum. Using the PIV, a ROC was generated with an AUC = 0.695. In the final model, a PIV <2 identified patients able to undergo an optimal MIS cytoreductive surgery with an accuracy of 68.2%. The specificity, or the ability to identify patients who would not be able to undergo an optimal MIS interval cytoreductive surgery, was 66.7%. CONCLUSION This predictive index model may help to guide future inclusion criteria in randomized studies evaluating the MIS approach in advanced epithelial ovarian cancer.
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Affiliation(s)
- Anthony B Costales
- Gynecologic Oncology, Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, United States of America.
| | - Erin K Crane
- Gynecologic Oncology, Levine Cancer Institute, Atrium Health System, United States of America
| | - Laura Chambers
- Gynecologic Oncology, Taussig Comprehensive Cancer Center, Cleveland Clinic, United States of America
| | - Meng Yao
- Quantitative Health Sciences, Cleveland Clinic, United States of America
| | - Danielle Chau
- Gynecologic Oncology, Taussig Comprehensive Cancer Center, Cleveland Clinic, United States of America
| | - Wendel R Naumann
- Gynecologic Oncology, Levine Cancer Institute, Atrium Health System, United States of America
| | - Robert Debernardo
- Gynecologic Oncology, Taussig Comprehensive Cancer Center, Cleveland Clinic, United States of America
| | - Stephanie Ricci
- Gynecologic Oncology, Taussig Comprehensive Cancer Center, Cleveland Clinic, United States of America
| | - Peter G Rose
- Gynecologic Oncology, Taussig Comprehensive Cancer Center, Cleveland Clinic, United States of America
| | - Chad M Michener
- Gynecologic Oncology, Taussig Comprehensive Cancer Center, Cleveland Clinic, United States of America
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Gallotta V, Certelli C, Oliva R, Rosati A, Federico A, Loverro M, Lodoli C, Foschi N, Lathouras K, Fagotti A, Scambia G. Robotic surgery in ovarian cancer. Best Pract Res Clin Obstet Gynaecol 2023; 90:102391. [PMID: 37573801 DOI: 10.1016/j.bpobgyn.2023.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 08/15/2023]
Abstract
Ovarian cancer (OC) represents one of the most lethal cancers in women. The aim of surgical treatment is complete cytoreduction in advanced stages and a surgical staging in early stages. Although the guidelines still suggest laparotomy as the standard approach, in recent years minimally invasive surgery (MIS) has become increasingly popular in the treatment of OC, especially in early stages, because the 5-year relative survival exceeds 90% and the patients' quality of life cannot be overshadowed. However, MIS has been demonstrated to have a role even in advanced stages, in the prediction of optimal cytoreduction, identification patients who may benefit from neoadjuvant chemotherapy, and, more recently, in the interval debulking surgery, as in selected cases of secondary cytoreduction for recurrent ovarian cancer. The aim of this review is to describe the MIS (especially robotic surgery), with its advantages and pitfalls, in the treatment of OC.
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Affiliation(s)
- Valerio Gallotta
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Camilla Certelli
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Oliva
- Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Rosati
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alex Federico
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Matteo Loverro
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Lodoli
- Department of General Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nazario Foschi
- Division of Urology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | | | - Anna Fagotti
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- Department of Woman, Child and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Institute of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
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3
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Jorgensen K, Melamed A, Wu CF, Nitecki R, Pareja R, Fagotti A, Schorge JO, Ramirez PT, Rauh-Hain JA. Minimally invasive interval debulking surgery for advanced ovarian cancer after neoadjuvant chemotherapy. Gynecol Oncol 2023; 172:130-137. [PMID: 36977622 PMCID: PMC10192032 DOI: 10.1016/j.ygyno.2023.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Assess outcomes of interval debulking surgery (IDS) after neoadjuvant chemotherapy via minimally invasive surgery (MIS) compared with laparotomy in patients with advanced epithelial ovarian cancer. METHODS Patients diagnosed with stage IIIC or IV epithelial ovarian cancer between 2013 and 2018 who received neoadjuvant chemotherapy and IDS were identified in the National Cancer Database. Primary outcome was overall survival. Secondary outcomes were 5-year survival, 30- and 90-day postoperative mortality, extent of surgery, residual disease, hospitalization duration, surgical conversions, and unplanned readmissions. Propensity score matching was used to compare MIS and laparotomy for IDS. Association of treatment approach with overall survival was assessed using Kaplan-Meier method and Cox regression. Sensitivity analysis was conducted for effect of unmeasured confounders. RESULTS A total of 7897 patients met inclusion criteria; 2021 (25.6%) underwent MIS. Percentage undergoing MIS increased from 20.3%-29.0% over the study period. After propensity score matching, median overall survival was 46.7 months in the MIS group versus 41.0 months in the laparotomy group [hazard ratio (HR) 0.86 (95%CI 0.79-0.94)]. Five-year survival probability was higher in MIS versus laparotomy (38.3% vs 34.8%, p < 0.01). There was lower 30- and 90-day mortality (0.3% vs 0.7% [p = 0.04] and 1.4% vs 2.5% [p = 0.01], respectively), shorter length of stay (median 3 vs 5 days, p < 0.01), lower residual disease (23.9% vs 26.7%, p < 0.01), and lower additional cytoreductive procedures (59.3% vs 70.8%, p < 0.01) in MIS compared to laparotomy, with similar rates of unplanned readmission (2.7% vs 3.1%, p = 0.39). CONCLUSIONS Patients who undergo IDS by MIS have similar overall survival and decreased morbidity compared with laparotomy.
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Affiliation(s)
- Kirsten Jorgensen
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Chi-Fang Wu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Roni Nitecki
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rene Pareja
- Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
| | - Anna Fagotti
- Department of Woman's and Child Health and Public Health Sciences, Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - John O Schorge
- Department of Obstetrics and Gynecology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Pedro T Ramirez
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jose Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Collin-Bund V, Lecointre L, Ross C, Faller E, Boisramé T, Minella C, Baldauf JJ, Akladios C. Preliminary observational study of the implementation of hyperthermic intraperitoneal chemotherapy in ovarian cancer in the gynecological surgery department at the University Hospital of Strasbourg. J Gynecol Obstet Hum Reprod 2023; 52:102501. [PMID: 36356941 DOI: 10.1016/j.jogoh.2022.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE According to French guidelines, hyperthermic intraperitoneal chemotherapy (HIPEC) can be performed for Federation of Gynecology and Obstetrics stage III primary epithelial ovarian, tubal, and peritoneal cancers that are initially unresectable after 3 or 4 cycles of intravenous chemotherapy. The main objective of this preliminary study was to analyze the components necessary for the establishment of HIPEC in an expert gynecological oncological surgery center. The secondary objective was to compare HIPEC using conventional laparotomy and laparoscopic approaches. METHODS We conducted a single-center retrospective study of patients who received HIPEC. All patients who met the criteria of the French HIPEC guidelines were included from 2019 to 2021. RESULTS Prior to HIPEC, there were a mean of 3.7 courses of neoadjuvant chemotherapy with carboplatin and paclitaxel. Of the 16 patients who received HIPEC, 9 (56.2%) underwent HIPEC laparoscopically, while 7 (43.8%) underwent laparotomy. There were no differences between the rates of intra- and postoperative complications between the two groups. (p > 0.05). The duration of hospitalization was significantly shorter in patients who were operated laparoscopically than in those treated using laparotomy (55.6% <10 days vs. 0 by laparotomy, p = 0.01). There was also a tendency, although not significant, for a more rapid resumption of adjuvant chemotherapy in the laparoscopy group, with 57.1% resuming chemotherapy in <6 weeks compared to 42.9% in the laparotomy group (p = 0.52). CONCLUSIONS This study demonstrates the feasibility of HIPEC in a center with expertise in gynecological surgery when there is a suitable technical platform and close collaboration between the different teams involved. We also showed the first cases of HIPEC using laparoscopy, which seems to be a promising approach.
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Affiliation(s)
- Virginie Collin-Bund
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| | - Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France; I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, 67081 Strasbourg, France; Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, 67081 Strasbourg, France
| | - Célia Ross
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Emilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Chris Minella
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Jean-Jacques Baldauf
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
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Lecointre L, Pellerin M, Venkatasamy A, Fabacher T, Eberst L, Gantzer J, Jochum F, Faller É, Boisramé T, Querleu D, Akladios C. Complete Laparoscopic Interval Debulking Surgery for Advanced Ovarian Cancer Achieves Similar Survival Outcomes to Open Approach: A Propensity-Matched Study. J INVEST SURG 2022; 35:1394-1401. [PMID: 35227150 DOI: 10.1080/08941939.2022.2045396] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: To assess the laparoscopic interval debulking surgery (IDS) outcomes compared to laparotomy, by analyzing the overall survival (OS) and the progression free survival (PFS), as well as the intra- and post-operative morbidity.Methods: In this retrospective propensity-score-matched cohort study, all patients with stage III or IV FIGO (International Federation of Gynecology and Obstetrics) serous ovarian cancer, undergoing complete IDS after neoadjuvant chemotherapy, from January 1st of 2009 to June 1st 2019, were included.Results: Thirty-seven patients were included in the laparoscopy group and 40 in the laparotomy group. There was no significant difference in terms of median OS between laparoscopy and laparotomy (23.1 months [95% CI 15.7-29.7] versus 26.3 months [95% CI 21.7-31.7], respectively, p = 0.17) and median PFS (14.8 months [95% CI 10.6-21.5] versus 12 months [95% CI 11-15.1], p = 0.057). After applying the propensity score, 25 patients were included in each group. Laparoscopy was associated with significantly less early postoperative complications (6 versus 17, p = 0.01) and shorter hospital stay (7.6 days versus 12.1, p < 0.001) and a significantly better OS (HR 0.45 [95% CI 0.19-0.95], p = 0.04), but with no significant difference in terms of PFS (HR 0.71 [95% CI 0.27-1.88], p = 0.49).Conclusion: In carefully-selected patients with advanced ovarian cancer, complete laparoscopic interval debulking surgery achieves similar survival outcomes to open laparotomy. Therefore, laparoscopy appears as a safe alternative to laparotomy for IDS after NACT in selected patients with advanced ovarian cancer and a low burden of disease.
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Affiliation(s)
- Lise Lecointre
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,I-Cube UMR 7357 - Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie, Université de Strasbourg, Strasbourg, France
| | - Madeleine Pellerin
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aïna Venkatasamy
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC, Interface Recherche Fondamental et Appliquée à la Cancérologie, Strasbourg, France
| | - Thibaut Fabacher
- Department of Public Health, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Lauriane Eberst
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Justine Gantzer
- Department of Medical Oncology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Floriane Jochum
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Émilie Faller
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thomas Boisramé
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Denis Querleu
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Chérif Akladios
- Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Psomiadou V, Prodromidou A, Fotiou A, Lekka S, Iavazzo C. Robotic interval debulking surgery for advanced epithelial ovarian cancer: current challenge or future direction? A systematic review. J Robot Surg 2020; 15:155-163. [PMID: 33037532 DOI: 10.1007/s11701-020-01155-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022]
Abstract
We evaluated the effectiveness, safety and efficacy of robotic interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) treated with neoadjuvant chemotherapy (NACT). We conducted a systematic review of the published relevant studies. Α total of 102 patients were evaluated. Mean operative time ranged from 164 to 312 min (mean ± SD: 246 ± 61 min) while mean estimated blood loss ranged from 106.9 to 262.5 ml (mean ± SD: 168 ± 68 ml) and postoperative blood transfusion rate was 19% (n = 19/98). Complete cytoreduction rate (R0 resection) was achieved in 75 patients (76.5%), whereas residual disease ≤ 1 cm in 21 women (21.5%). Mean hospital stay was 2.4 days. No intraoperative and six postoperative (14.6%) complications were reported. Laparotomy conversion rate was 9.2% (9/98) mostly in the terms of achieving complete cytoreduction and 30-day mortality rate was 9.2% (n = 9/98). The median overall survival varied from 39.7 to 47.2 months, while the progression-free survival ranged from 20.6 to 21.2 months during a median follow-up period from 2 to 86 months (median 25.3 months). A total of 60 women (61%) developed disease recurrence. One of the studies reported significantly improved OS and PFS in patients who underwent robotic IDS when compared to those who had laparotomy either during or before the addition of robotic surgery in the management of advanced ovarian cancer disease (47.2 vs 37.8 vs 37.9, p = 0.004 for OS and 20.6 vs 13.9 vs 11.9, p = 0.005 for PFS, respectively). The same was also observed when controlling the parameters of age and stage for patients in the robotic arm (p = 0.02). Robotic interval debulking surgery can be considered in the management of advanced ovarian cancer patients after receiving neoadjuvant chemotherapy. Larger meta-analyses including multicenter randomized control trials are necessary to specify the exact profile of the patients that could benefit from this treatment strategy.
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Affiliation(s)
- Victoria Psomiadou
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Mpotasi 51, 18537, Piraeus, Greece
| | - Anastasia Prodromidou
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Mpotasi 51, 18537, Piraeus, Greece
| | - Alexandros Fotiou
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Mpotasi 51, 18537, Piraeus, Greece
| | - Sofia Lekka
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Mpotasi 51, 18537, Piraeus, Greece.
| | - Christos Iavazzo
- Department of Gynecologic Oncology, Metaxa Cancer Hospital, Mpotasi 51, 18537, Piraeus, Greece
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Jochum F, Vermel M, Faller E, Boisrame T, Lecointre L, Akladios C. Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E2507. [PMID: 32759715 PMCID: PMC7463583 DOI: 10.3390/jcm9082507] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/27/2020] [Accepted: 07/30/2020] [Indexed: 12/24/2022] Open
Abstract
As regards ovarian cancer, the use of minimally invasive surgery has steadily increased over the years. Reluctance persists, however, about its oncological outcomes. The main objective of this meta-analysis was to compare the three and five-year mortality of patients operated by minimally invasive surgery (MIS) for ovarian cancer to those operated by conventional open surgery (OPS), as well as their respective perioperative outcomes. PubMed, Cochrane library and CinicalTrials.gov were systematically searched, using the terms laparoscopy, laparoscopic or minimally invasive in combination with ovarian cancer or ovarian carcinoma. We finally included 19 observational studies with a total of 7213 patients. We found no statistically significant difference for five-year (relative risk (RR) = 0.89, 95% CI 0.53-1.49, p = 0.62)) and three-year mortality (RR = 0.95, 95% CI 0.80-1.12, p = 0.52) between the patients undergoing MIS and those operated by OPS. When five and three-year recurrences were analyzed, no statistically significant differences were also observed. Analysis in early and advanced stages subgroups showed no significant difference for survival outcomes, suggesting oncological safety of MIS in all stages. Whether the surgery was primary or interval debulking surgery in advanced ovarian cancer, did not influence the comparative results on mortality or recurrence. Although the available studies are retrospective, and mostly carry a high risk for bias and confounding, an overwhelming consistency of the evidence suggests the likely effectiveness of MIS in selected cases of ovarian cancer, even in advanced stages. To validate the use of MIS, the development of future randomized interventional studies should be a priority.
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Affiliation(s)
| | | | | | | | | | - Cherif Akladios
- Department of Gynecology, Strasbourg University Hospital, 67000 Strasbourg, France; (F.J.); (M.V.); (E.F.); (T.B.); (L.L.)
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8
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Tian C, Song W, Tian X, Sun Y. Prognostic significance of platelet-to-lymphocyte ratio in patients with ovarian cancer: A meta-analysis. Eur J Clin Invest 2018; 48:e12917. [PMID: 29469190 DOI: 10.1111/eci.12917] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 02/18/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The platelet-to-lymphocyte ratio (PLR) has been found to predict clinical outcomes in borderline ovarian tumours and the other genital neoplasms. However, its prognostic value in patients with ovarian cancer remains controversial. The aim of this study was to assess its prognostic value in ovarian cancer. METHODS We searched MEDLINE, EMBASE and the Cochrane databases to identify studies evaluating the prognostic significance of pretreatment PLR in ovarian cancer. The end points were overall survival (OS) and progression-free survival (PFS). Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using fixed-effects/random-effects models. RESULTS A total of 11 studies comprising 3574 patients with ovarian cancer were included. The random-effects meta-analysis demonstrated that patients with elevated PLR had shorter OS (HR: 1.48, 95% CI: 1.24-1.76, P < .001) and PFS (HR: 1.38, 95% CI: 1.17-1.63, P < .001). The negative prognostic impact of high PLR on OS and PFS remained substantial in Asian populations, patients with PLR ≥ 200 and studies with NOS score ≥ 7. CONCLUSIONS Elevated pretreatment PLR could be an unfavourable prognostic factor for clinical outcomes in patients with ovarian cancer.
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Affiliation(s)
- Chuan Tian
- Department of Nuclear Medicine, Guizhou Provincial People's Hospital, Guizhou, China
| | - Wei Song
- Department of Intervention and Vascular Surgery, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou Cancer Medical Center, Suzhou, China
| | - Xia Tian
- Department of Nuclear Medicine, Guizhou Provincial People's Hospital, Guizhou, China
| | - Yong Sun
- Center for Reproductive Medicine, Linyi People's Hospital, Linyi, China
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9
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Liang H, Guo H, Zhang C, Zhu F, Wu Y, Zhang K, Li H, Han J. Feasibility and outcome of primary laparoscopic cytoreductive surgery for advanced epithelial ovarian cancer: a comparison to laparotomic surgery in retrospective cohorts. Oncotarget 2017; 8:113239-113247. [PMID: 29348902 PMCID: PMC5762587 DOI: 10.18632/oncotarget.22573] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 10/02/2017] [Indexed: 01/17/2023] Open
Abstract
Objectives To assess the feasibility and outcome of primary laparoscopic cytoreductive surgery on advanced epithelial ovarian cancer in comparison with conventional open surgery. Materials and Methods Patients undergoing primary laparoscopic cytoreductive surgery (LCS) from March 2007 to December 2016 were matched to controls treated with laparotomic cytoreduction during the same period. Procedural data and outcomes were analyzed. Results The LCS group (n = 64) and laparotomic group (n = 68) had similar age, BMI, stages, histologic type and grading. The LCS group exhibited significantly less operating time (P < 0.001), less intraoperative blood loss (P < 0.001), and shorter time to recover postoperatively (P = 0.002). No statistical difference was observed for the number of pelvic and para-aortic lymph nodes dissected (P = 0.326 and P = 0.151). Significant difference was observed in satisfaction of the cytoreduction (95.3% vs. 76.5%, P = 0.008). No significant difference were observed either in intra-operative or in post-operative complications between the two groups (P = 0.250). Three patients in the LCS group experienced intra-operative complications (4.7%) and were all treated laparoscopically. The conversion rate was 3.1%. No significant differences were observed in the progression-free survival and overall survival between the two groups during the medium follow-up of 18 months (P = 0.236 and P = 0.216). The 2-year and 3-year progression-free survival was 67.9%, 55.5% in LCS group and 53.8%, 33.3% respectively in the control group. The 2-year and 3-year overall survival was 95.8%, 88.7% respectively in the LCS group and 89.0%, 83.7% in the control group. Conclusions Primary laparoscopic cytoreductive surgery in some strictly selected advanced stages of EOC patients was feasible and safe, resulting in oncologic outcomes not inferior to those in open surgery.
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Affiliation(s)
- Huamao Liang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Hongyan Guo
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Chunyu Zhang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - FuLi Zhu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Yu Wu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Kun Zhang
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Hua Li
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
| | - Jinsong Han
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, P.R. China
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