Introduction/Background To investigate the efficacy and safety of laparoscopic cytoreduction surgery for primary and recurrent ovarian cancer in a strictly selected group of patients.
Methodology From June 2008 to January 2020, FIGO stage IIIA-IV advanced ovarian cancer(AOC) patients were rigorously selected for laparoscopic primary (PDS), interval (IDS), or secondary debulking surgeries (SC). The primary endpoint was optimal cytoreduction, defined as residual tumor (RT) less than 1 cm. The secondary endpoints, safety and long-term results, were investigated every three months for the first two years, then every six months.
Results 108 patients with AOC were selected to undergo laparoscopic PDS (40 patients), IDS (44 patients), and SC (24 patients) surgeries. Optimal cytoreduction (RT=0) was obtained in 96%, 89%, and 88% of patients after SC, IDS, and PDS, respectively. Early post-operative complications occurred in 19% of cases, with 7% requiring a reintervention. One patient died of respiratory failure in the immediate post-operative period. Late postoperative complications occurred in 15%, 7%, and 4% of cases following PDS, IDS, and SC. The recurrence rate observed was 37% after laparoscopic optimal cytoreduction with a median observation time of 25 months. The overall survival (OS) at three and five years was 84% and 67% after PDS, and 66% and 32% after IDS. Three-year disease-free survival (DFS) was 48% and 51% after PDS and IDS, respectively.
Conclusion Minimal invasive laparoscopic surgery for AOC is feasible in strictly selected patients with high rates of optimal cytoreduction, satisfactory peri-operative morbidity, and encouraging survival outcomes.
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