REVIEW  UPDATES IN OVARIAN CANCER AND SECONDARY PERITONEAL TUMORS 

Minerva Medica 2019 August;110(4):341-57

DOI: 10.23736/S0026-4806.19.06132-9

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Laparoscopy vs. laparotomy for advanced ovarian cancer: a systematic review of the literature

Salvatore GUELI ALLETTI ¹ ✉, Vito A. CAPOZZI ^{1, 2}, Andrea ROSATI ^{1, 2}, Ilaria DE BLASIS ¹, Stefano CIANCI ¹, Giuseppe VIZZIELLI ¹, Stefano UCCELLA ³, Valerio GALLOTTA ¹, Francesco FANFANI ^{1, 2}, Anna FAGOTTI ^{1, 2}, Giovanni SCAMBIA ^{1, 2}

¹ Division of Gynecologic Oncology, Department of Women and Children’s Health, A. Gemelli University Hospital and Institute for Research and Care, Rome, Italy; ² Division of Gynecologic Oncology, Sacred Heart Catholic University, Policlinico A. Gemelli Foundation, Rome, Italy; ³ Department of Obstetrics and Gynecology, Ospedale degli Infermi, ASL Biella, Biella, Italy

INTRODUCTION: In the last decade, laparoscopy has been progressively introduced in the management of advanced-stage ovarian cancer (AOC) to evaluate tumor resectability, avoiding an explorative laparotomy, to identify non-responders to submit to second-line chemotherapy and to perform primary or interval minimally invasive debulking surgery in selected patients. This review aims to deeply focus on the differences between laparoscopy and laparotomy in the management of advanced ovarian cancer.
EVIDENCE ACQUISITION: The electronic database search provided a total of 80 results. Out of these, 63 results were excluded because considered not relevant to the review, for linguistic reasons or case reports. A total of 17 articles were considered eligible for the review.
EVIDENCE SYNTHESIS: Many studies have assessed the value of laparoscopy in predicting the optimal resectability of AOC patients avoiding exploratory laparotomies. More recently, its role in primary and interval cytoreduction has been investigated for selected patients in terms of safety, feasibility and oncological outcomes. Published data are comparable to the standard laparotomic management in terms of oncological outcomes but with improved perioperative and psychological results. The selection of patients is crucial to perform a successful surgery.
CONCLUSIONS: To date, laparoscopy has replaced the primary laparotomic approach in the evaluation of optimal resectability. As far as primary and interval minimally invasive debulking surgery are concerned, instead, most of the works report an overlap of oncological outcomes compared to traditional surgery. The selection of patients is a crucial point to reach a successful minimally invasive surgical treatment, taking into account surgical complexity and surgical adequacy.

KEY WORDS: Ovarian neoplasms; Laparoscopy; Laparotomy; Minimally invasive surgical procedures