Oncologic concerns regarding laparoscopic cytoreductive surgery in patients with advanced ovarian cancer submitted to neoadjuvant chemotherapy

Abstract

Ovarian cancer is the second most common gynecological malignant neoplasm in western countries and it is indeed the most lethal form among them. In Brazil, ovarian carcinoma is the third most frequent cancer of the female genital tract, exhibiting a clear tendency of increment in recent years. About 80% of the affected women are diagnosed in advanced stages of the disease, in which the prognosis is very poor. The modern treatment of ovarian cancer is multimodal, based on surgery and chemotherapy. To date, the sequence of these therapies is still a reason of intense debate among specialists. Along the last decades, primary surgery followed by adjuvant chemotherapy has been considered the standard approach. Debulking surgery must be guided by the principle of maximum cytoreduction, but in a significant number of patients, the procedure is simply not feasible due to technical or clinical reasons. In order to increase the rates of complete surgical resection and improve the overall performance of the patients, the concept of neoadjuvant chemotherapy was introduced into clinical practice. Consequently, complex procedures with significant morbidity and mortality are often replaced by more restricted interventions. It is well know that laparoscopy significantly reduces surgical morbidity and expedites recovery. Although there is a notorious paucity of data regarding oncological safety of laparoscopic cytoreduction in advanced ovarian cancer, a recent editorial published by Nezhat et al in 2013 highlights the potential role of minimally invasive surgery in the era of neoadjuvant chemotherapy. In order to investigate current speculations in regard to the use of laparoscopy in advanced ovarian cancer, we developed a pilot study to evaluate the feasibility and oncologic safety of cytoreduction endoscopically performed in selected patients. (AU)