In a Dutch trial reported in the Journal of Clinical Oncology, Rutten et al found that initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery in patients with suspected advanced-stage ovarian cancer.
In the trial, 201 women who were qualified for primary cytoreductive surgery from 8 centers in the Netherlands were randomized between May 2011 and February 2015 to undergo diagnostic laparoscopy (n = 102) or primary surgery (n = 99). Laparoscopy was used to guide the selection of primary treatment, consisting of primary surgery or neoadjuvant chemotherapy followed by interval surgery. The primary outcome was futile laparotomy, defined as primary cytoreductive surgery with residual disease of > 1 cm.
Reduction in Futile Laparotomies
Primary cytoreductive surgery was performed in 63 patients (62%) in the laparoscopy group and 93 patients (94%) in the primary surgery group. Futile laparotomy occurred in 10 patients (10%) in the laparoscopy group vs 39 patients (39%) in the primary surgery group (relative risk = 0.25, P < .001). Both primary and interval surgeries were performed in 3 patients (3%) in the laparoscopy group vs 28 patients (28%) in the primary surgery group (P < .001).
The investigators concluded: “Diagnostic laparoscopy reduced the number of futile laparotomies in patients with suspected advanced-stage ovarian cancer. In women with a plan for [primary cytoreductive surgery], these data suggest that performance of diagnostic laparoscopy first is reasonable and that if cytoreduction to < 1 cm of residual disease seems feasible, to proceed with [primary cytoreductive surgery].”
The study was supported by the Dutch Organization for Health Research and Development.
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