Role of diagnostic laparoscopy in deciding primary treatment in advanced-stage ovarian cancer

Abstract

Objective: We evaluated the usefulness of preoperative diagnostic laparoscopy for treatmentplanning in patients with advanced-stage ovarian cancer.

Methods: We retrospectively analyzed 614 patients diagnosed with advanced-stage ovariancancer between Januar y 2010 and May 2018. Primar y debulking surger y (PDS) or neoadjuvantchemotherapy (NAC) followed by inter val debulking surger y were selected based onpreoperative laparoscopic (Group 1, n=192) and computed tomography findings (Group 2,n=422). The primar y outcomes in the PDS and NAC groups were suboptimal cytoreduction(residual disease >1 cm) rate and non-high-grade serous carcinoma (non-HGSC) rate,respectively.

Results: The patients who under went PDS in group 1 and group 2 were 49 (25.5%) and 279(66.1%), respectively. The suboptimal cytoreduction rate after PDS was lower in Group 1than in Group 2 (2.0% vs 11.1%, p=0.023). Moreover, Group 1 showed a tendency toward alower proportion of non-HGSC patients who under went NAC than that in Group 2 (9.1%vs. 15.4%, p=0.069). Further, Group 1 showed lower rates of postoperative morbidity thanGroup 2 (5.2% vs. 10.4%, p=0.033). However, Kaplan–Meier analysis showed no significantdifferences in sur vival outcomes between the 2 groups.

Conclusion: Diagnostic laparoscopy reduced the suboptimal cytoreduction rate in the PDSgroup and the implementation rate of NAC in non-HGSC patients. Moreover, it reducedpostoperative morbidity without affecting sur vival in both groups. Thus, diagnosticlaparoscopy is a valuable diagnostic tool for determining the primar y treatment.