Laparoscopic debulking surgery in the management of advanced ovarian cancer after neoadjuvant chemotherapy

Objective The purpose of this study was to evaluate the feasibility and morbidity of total laparoscopic debulking surgery in the treatment of advanced ovarian cancer after neoadjuvant chemotherapy. Methods/Materials We performed a retrospective review of laparoscopic approach in patients with histologically confirmed epithelial ovarian cancer (International Federation of GynaecologyObstetrics stages IIIC-IV) who received 3 courses of neoadjuvant chemotherapy, from January 2010 to December 2014, at the Gynaecologic Oncologic Unit, "Regina Elena" National Cancer Institute, Rome, Italy. Results A total of 30 patients were included. The median age was 50 years (range, 26-73 years), median body mass index was 24.5 kg/m² (range, 19-39 kg/m²). All patients had good clinical response to 3 cycles of neoadjuvant chemotherapy. All women underwent a complete debulking surgery with no residual disease. The median operating time was 152 minutes (range, 70-335 minutes), the median blood loss was 70 mL (range, 50-200 mL). The median number of removed pelvic lymph nodes was 15 (range, 13-25). There was 1 (3.3%) intraoperative complication and 2 (6.6%) postoperative short-term complications. The median length of hospital stay was 4 days (range, 3-13 days). The median follow-up was 15 months (range, 2-54 months). Twenty-six patients are free from recurrence at the time of this report. Conclusions Laparoscopic cytoreduction in patients with advanced ovarian cancer after neoadjuvant chemotherapy, when performed by skilled surgeons, seems feasible and may decrease the impact of aggressive surgery on high-morbidity patients, such as on women after chemotherapy.