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Laparoscopic cytoreduction After Neoadjuvant ChEmotherapy (LANCE)
  1. Roni Nitecki1,
  2. Jose Alejandro Rauh-Hain1,
  3. Alexander Melamed2,
  4. Giovanni Scambia3,4,
  5. Rene Pareja5,
  6. Robert L Coleman6,
  7. Pedro T Ramirez1 and
  8. Anna Fagotti3,4
  1. 1Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
  3. 3Department of Women's and Children's Health, Policlinico A Gemelli, Rome, Italy
  4. 4Catholic University Sacred Heart, Rome, Italy
  5. 5Instituto Nacional de Cancerología, Bogotá, and Clínica de Oncología Astorga, Medellin, Colombia
  6. 6The US Oncology Network, The Woodlands, Texas, USA
  1. Correspondence to Dr Jose Alejandro Rauh-Hain; jarauh{at}


Background Observational studies have supported the practice of offering minimally invasive interval debulking surgery after neoadjuvant chemotherapy for well-selected patients with advanced epithelial ovarian cancer. However, there are no prospective randomized data comparing the oncologic efficacy of minimally invasive and open interval debulking surgery in epithelial ovarian cancer.

Primary objective The primary objective of this study is to examine whether minimally invasive surgery is non-inferior to laparotomy in terms of disease-free survival in women with advanced stage epithelial ovarian cancer that responded to three or four cycles of neoadjuvant chemotherapy.

Study hypothesis We hypothesize that in patients who had a complete or partial response to neoadjuvant chemotherapy, minimally invasive interval debulking surgery is not inferior to laparotomy.

Trial design The Laparoscopic cytoreduction After Neoadjuvant ChEmotherapy (LANCE) trial is an international, prospective, randomized, multicenter, non-inferiority phase III trial to compare minimally invasive surgery vs laparotomy in women with advanced stage high-grade epithelial ovarian cancer that had a complete or partial response to three or four cycles of neoadjuvant chemotherapy and normalization of CA-125. The first 100 participants will be enrolled into a pilot lead-in to determine feasibility. The study will be considered feasible and will continue to Phase III under the following conditions: the accrual rate reaches at least 80% of the target rate after all pilot sites are open; the crossover rate in the minimally invasive group is less than 25%; and the difference of complete gross resection between the minimally invasive and open group is less than 20%. If the study is determined to be feasible, all remaining participants will be enrolled into the Phase III stage.

Major inclusion/exclusion criteria Patients with stage IIIC or IV high-grade epithelial ovarian, primary peritoneal or fallopian tube carcinoma who had a complete or partial response to three or four cycles of neoadjuvant chemotherapy based on imaging and normalization of CA-125 will be enrolled. Patients with evidence of tumor not amenable to minimally invasive resection on pre-operative imaging will be excluded.

Primary endpoint The primary endpoint is non-inferiority of disease-free survival in minimally invasive vs laparotomic interval debulking surgery.

Sample size To demonstrate non-inferiority with a margin of 33% in the hazard ratio (HR=1.33), 549 patients will be randomized.

  • gynecologic surgical procedures
  • ovarian cancer
  • surgical oncology

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  • Twitter @pedroramirezMD, @annafagottimd

  • Contributors All authors contributed equally.

  • Funding Supported by The National Institute of Health’s National Cancer Institute Grants (K08CA234333; JARH), a National Cancer Institute Cancer Center Support Grant (P30 48CA016672), and a National Institutes of Health T32 grant (#5T32 CA101642; RN).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Data availability statement There are no data in this work