Laparoscopy to predict the result of primary cytoreductive surgery in advanced ovarian cancer patients (LapOvCa-trial): a multicentre randomized controlled study Minimally invasive interval debulking surgery in ovarian neoplasm (MISSION trial-NCT02324595): a feasibility study. Influence of Intraperitoneal Dissemination Assessed by Laparoscopy on Prognosis of Advanced Ovarian Cancer: An Exploratory Analysis of a Single-Institution Experience Outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents: an intergroup study. Laparoscopic fertility-sparing staging in unexpected early stage ovarian malignancies. Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy Implications of second-look laparotomy in the context of optimally resected stage III ovarian cancer: a non-randomized comparison using an explanatory analysis: a Gynecologic Oncology Group study. Prognostic factors for stage III epithelial ovarian cancer: a Gynecologic Oncology Group Study. Surgery in Recurrent Ovarian Cancer: The Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) DESKTOP OVAR Trial Consolidation radiotherapy after carboplatin-based chemotherapy in radically operated advanced ovarian cancer. Cost-effective treatment of women with advanced ovarian cancer by cytoreductive surgery and chemotherapy directed by an in vitro assay for drug resistance. Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety Long-term survival and prognostic factors in advanced epithelial ovarian cancer with special emphasis upon the effects of protocol inclusion Specialized and high-volume care leads to better outcomes of ovarian cancer treatment in the Netherlands. Long-term follow-up of patients with advanced ovarian cancer treated in randomised clinical trials. A national cancer institute sponsored screening trial for prostatic, lung, colorectal, and ovarian cancers Stage‐ and CA125–related survival in patients with epithelial ovarian cancer treated at a cancer center
Background St and ard treatment of advanced ovarian cancer is surgery and chemotherapy . The goal of surgery is to remove all macroscopic tumour , as the amount of residual tumour is the most important prognostic factor for survival . When removal off all tumour is considered not feasible , neoadjuvant chemotherapy ( NACT ) in combination with interval debulking surgery ( IDS ) is performed . Current methods of staging are not always accurate in predicting surgical outcome , since approximately 40 % of patients will have more than 1 cm residual tumour after primary debulking surgery ( PDS ) . In this study we aim to assess whether adding laparoscopy to the diagnostic work-up of patients suspected of advanced ovarian carcinoma may prevent unsuccessful primary debulking surgery for ovarian cancer . Methods Multicentre r and omized controlled trial , including all gynaecologic oncologic centres in the Netherl and s and their affiliated hospitals . Patients are eligible when they are planned for PDS after conventional staging . Participants are r and omized between direct PDS or additional diagnostic laparoscopy . Depending on the result of laparoscopy patients are treated by PDS within three weeks , followed by six courses of platinum based chemotherapy or with NACT and IDS 3 - 4 weeks after three courses of chemotherapy , followed by another three courses of chemotherapy . Primary outcome measure is the proportion of PDS 's leaving more than one centimetre tumour residual in each arm . In total 200 patients will be r and omized . Data will be analysed according to intention to treat . Discussion Patients who have disease considered to be resectable to less than one centimetre should undergo PDS to improve prognosis . However , there is a need for better diagnostic procedures because the current number of debulking surgeries leaving more than one centimetre residual tumour is still high . Laparoscopy before starting treatment for ovarian cancer can be an additional diagnostic tool to predict the outcome of PDS . Despite the absence of strong evidence and despite the possible complications , laparoscopy is already implemented in many countries . We propose a r and omized multicentre trial to provide evidence on the effectiveness of laparoscopy before primary surgery for advanced stage ovarian cancer patients .Trial registration Netherl and s Trial Register number BACKGROUND Laparoscopy has acquired an increasing role in the management of ovarian cancer . Laparoscopic cytoreduction could represent a new frontier for selected patients after neoadjuvant chemotherapy ( NACT ) .  OBJECTIVE We sought to assess feasibility and early complication rate of minimally invasive ( MI ) interval debulking surgery ( IDS ) in stage III-IV epithelial ovarian cancer ( EOC ) patients after NACT .  STUDY DESIGN This is a phase II multicentric study in advanced EOC cases with clinical complete response after NACT , according to Gynecologic Cancer Intergroup and Response Evaluation Criteria In Solid Tumors criteria . Institutional review board approval was obtained and all patients signed written informed consent to be included in the protocol . The study was registered in clinical trials.gov ( NCT02324595 ) and was named " MISSION " trial . For patients meeting inclusion criteria , surgical procedures started with diagnostic laparoscopy to confirm preoperative findings and assess surgical complexity . MI-IDS included hysterectomy , bilateral salpingo-oophorectomy , appendectomy , omentectomy , peritonectomy , and bowel resection . Pelvic and /or aortic lymphadenectomy was not considered as st and ard procedure in these cases . Intraoperative and postoperative outcomes , time to restart chemotherapy , survival rate , and quality of life data were registered . RESULTS From December 2013 through February 2015 , of 184 advanced EOC patients considered eligible for IDS , 52 ( 28.2 % ) met inclusion criteria and were enrolled in the study . For 22 ( 12 % ) of them , st and ard laparotomic approach was preferred because of intraoperative surgeon evaluation . Thirty ( 16.3 % ) patients received the planned treatment of MI-IDS . Median age was 61 ( range 39 - 81 ) years and median body mass index was 24 ( range 20 - 31 ) kg/m(2 ) .  Median numbers of NACT cycles was 4 ( range 3 - 7 ) . Median operative time was 285 ( range 124 - 418 ) minutes and median estimated blood loss was 100 ( range 50 - 200 ) mL. Surgical procedures included 28 ( 93.3 % ) hysterectomy and bilateral salpingo-oophorectomy , 29 ( 96.6 % ) omentectomy , 2 ( 6.6 % ) appendectomy , 11 ( 36.6 % ) regional peritonectomy , and 1 ( 3.4 % ) bowel resection . A residual tumor of 0 cm was reached in 29 ( 96.6 % ) patients and 0.5 cm in only 1 ( 3.4 % ) case . The vast majority of patients were discharged on postoperative day 2 ( range 2 - 3 ) . No early postoperative complications were registered . Median time to restart chemotherapy was 20 ( 10 - 30 ) days and all patients successfully completed the cycles . Histological findings showed 3 ( 10 % ) complete response , 9 ( 30 % ) microscopic residual disease , and 18 ( 60 % ) evidence of macroscopic residual disease . With a median follow-up of 10.5 month , 5 peritoneal and 2 lymph nodal recurrences were observed . Psychometric test revealed moderate discomfort in the vast majority of patients ( 66.7 % ) . All patients are still alive . CONCLUSION Invasive-IDS in patients with clinical ly complete response to NACT seems to be feasible and safe in terms of perioperative outcomes , psycho-oncological impact , and survival rate . The equivalence between MI surgery and laparotomy needs to be confirmed with a longer follow-up and a larger number of patients Purpose The aim of this study was to investigate whether preoperative laparoscopic evaluation of the dissemination of disease may have an independent impact on survival in advanced epithelial ovarian cancer ( AEOC ) . Methods All AEOC women were su bmi tted to staging laparoscopy before receiving primary debulking surgery ( PDS ) or neoadjuvant chemotherapy ( NACT ) . All study women received a laparoscopic score ( predictive index value [ PIV ] ) and were stratified into three groups based on volume of disease : high tumor load ( HTL ) for PIV ≥8 , intermediate tumor load ( ITL ) for PIV equal to 6 and 4 , and low tumor load ( LTL ) for PIV < 4 . Surgical and survival outcome were evaluated by univariate and multivariate analysis . Results Among 348 consecutive patients , almost half ( 48.0 % ) had an HTL . Among 165 cases receiving PDS , residual tumor ( RT ) was as follows : no gross residual in 102 patients ( 61.8 % ) ; RT ≤1 cm in 48 patients ( 29.1 % ) and RT > 1 cm in 15 cases ( 9.1 % ) . When stratifying the whole population according to laparoscopic tumor load , the median progression-free survival ( PFS ) was 33 months for LTL , 18 months for ITL , and 14 months for HTL ( p = 0.0001 ) . The median overall survival ( OS ) with respect to laparoscopic PIV was not reached for LTL , whereas it was 47 months for ITL and 33 months for HTL , respectively ( p = 0.0001 ) . At multivariate analysis , tumor load stratified by PIV retained an independent prognostic value on PFS and OS , together with RT and performance status . Conclusions RT remains an important prognostic factor in patients with AEOC , but tumor dissemination can play a role in determining prognosis in these women PURPOSE The aim of this study was to perform an evaluation of outcome and the role of surgical staging components in malignant germ cell tumors ( GCT ) of the ovary in children and adolescents . METHODS From 1990 to 1996 , 2 intergroup trials for malignant GCT were undertaken by Pediatric Oncology Group ( POG ) and Children 's Cancer Study Group ( CCG ) . Stage I-II patients were treated with surgical resection and 4 cycles of st and ard dose cisplatin ( 100 mg/m2/cycle ) , etoposide , and bleomycin ( PEB ) chemotherapy . Stage III-IV patients were treated with surgical resection and r and omly assigned to chemotherapy with PEB or high-dose cisplatin ( 200 mg/m2/cycle ) with etoposide and bleomycin ( HDPEB ) . Patients unresectable at diagnosis had second-look operation after 4 cycles of chemotherapy if residual tumor was seen on imaging studies . IRB approval of the protocol s was obtained at each participating institution . An analysis of outcome data , operative notes , and pathology reports in girls with ovarian primary site was done for this report . RESULTS There were 131 patients with ovarian primary tumors of 515 entered on these studies . Mean age was 11.9 years ( range , 1.4 to 20 years ) .  Six-year survival rate was stage , I 95.1 % ; stage II , 93.8 % ; stage III , 98.3 % ; stage IV , 93.3 % . In only 3 of 131 patients were surgical guidelines followed completely . Surgical omissions result ing in protocol noncompliance result ed from failure to biopsy bilateral nodes ( 97 % ) , no omentectomy ( 36 % ) , no peritoneal cytology ( 21 % ) , no contralateral ovary biopsy ( 59 % ) . More aggressive procedure than recommended by guidelines included total hysterectomy and bilateral salpingo-oophorectomy in 6 patients and retroperitoneal node dissection in 10 patients . Correlation of gross operative findings with pathology results was carried out for ascites , lymph nodes , implants , omentum , and contralateral ovary . CONCLUSIONS Pediatric ovarian malignant GCT ( stages I-IV ) have excellent survival with conservative surgical resection and platinum-based chemotherapy . Survival appears to have been unaffected by deviations from surgical guidelines . New surgical guidelines are proposed based on correlation of gross findings , histology , and outcome in these intergroup trials OBJECTIVE To assess feasibility and safety of fertility-sparing laparoscopic staging in women affected by unexpected ovarian cancer desiring to preserve their fertility . DESIGN Prospect i ve study . SETTING University clinic . PATIENT(S ) Twenty-seven patients already operated on elsewhere for a presumably benign ovarian cyst . INTERVENTION(S ) Laparoscopic fertility-sparing staging operations . MAIN OUTCOME MEASURE(S ) Perioperative and survival data , reproductive outcome . RESULT ( S ) Histologic findings after first surgery : 12 low malignant potential neoplasms , 11 invasive epithelial ovarian carcinomas,1 sex-cord stromal , and 3 germ cell neoplasms . Fertility-sparing staging consisted of exploration of the peritoneal cavity , peritoneal washing cytology , multiple peritoneal biopsies , omolateral adnexectomy ( except in borderline tumors ) , omentectomy , omolateral or bilateral pelvic and aortic lymph node sampling ( except in borderline tumors , well differentiated , mucinous , and granulosa cell ( GC ) neoplasms ) , endometrial biopsy , appendectomy in mucinous type . Overall , seven patients ( 26 % ) were upstaged . Six patients received adjuvant platinum-based chemotherapy . Two term pregnancies occurred . After a median follow-up of 20 months all patients are alive ; one patient has FIGO stage Ic clear cell carcinoma , which recurred 8 months after surgery . CONCLUSION ( S ) Laparoscopic fertility-sparing staging in early ovarian malignancies is feasible and safe in selected and counseled patients and should be performed in experienced gynecological oncology centers trained in endoscopic procedures Background : Presently , the use of laparoscopy in advanced ovarian cancer ( AOC ) is extremely controversial . In the era of neoadjuvant chemotherapy ( NACT ) , endoscopic debulking surgery could be a reasonable alternative for selected patients with primarily unresectable disease . Objectives : To evaluate the feasibility as well as the operative and oncologic safety of laparoscopic debulking surgery in patients with AOC su bmi tted to NACT . Methods : This is a pilot observational study on initially unresectable , high- grade serous ovarian cancer treated with a sequence of 6 cycles of carboplatin and paclitaxel followed by debulking surgery performed by laparoscopy ( group 1 ) or laparotomy ( group 2 ) . The inclusion criteria were clinical complete response , CA-125 normalization , imaging without disease in critical areas , and optimal cytoreduction . Results : From January 2011 to March 2014 , 21 patients were included . Ten women underwent laparoscopy and 11 laparotomy . No epidemiological or oncologic differences were observed between the groups . No surgery-related casualties , intraoperative complications , conversion to laparotomy , or excessive blood loss or transfusion was detected in the laparoscopic procedures . The mean time of operation was 292 min . The length of hospital stay averaged 3.6 days . Two women in group 1 developed relevant complications . After a mean follow-up of 20 months , the recurrence rates were similar , i.e. 80 % in group 1 versus 88 % in group 2 . Although statistical significance was not reached , the mortality related to cancer was considerably higher ( 20 vs. 0 % ; p = 0.086 ) and the mean chemotherapy-free interval was markedly shorter in group 1 ( 13.3 vs. 20.5 months ; p = 0.288 ) . Conclusion : Laparoscopic optimal debulking surgery after NACT is feasible and effective in selected patients . Nevertheless , laparoscopy was substantially associated with inferior oncologic results . Endoscopic cytoreduction in AOC should be cautiously suggested until larger prospect i ve trials confirm the observed results OBJECTIVE A non-r and omized comparison of outcome in women undergoing second-look laparotomy ( SLL ) or clinical follow-up , after receiving six cycles of combination chemotherapy with paclitaxel plus either cisplatin or carboplatin , for optimally resected stage III ovarian cancer . METHODS Prior to chemotherapy r and omization , patients chose whether or not to undergo SLL ; this was a stratification factor to insure balance of treatment assignment . Any subsequent therapy was physician-directed . Explanatory analysis replaced intent-to-treat because of a higher likelihood of detecting SLL effect in the presence of noncompliance . RESULTS There were 393 patients ( median age : 54 ) who Elected SLL and 399 ( median age : 59 ) who Elected No SLL . The former group was more likely to have gross residual disease at initial surgery than the latter group ( 69 % versus 60 % , respectively ) . In the Elected SLL group , 59 ( 15 % ) patients subsequently refused surgery , in nine ( 2 % ) surgery was contraindicated , and 31 ( 8 % ) relapsed or died prior to the procedure . Cancer was found in 46 % of 294 ( 75 % ) patients undergoing SLL . Since early failures ( prior to SLL ) do not address benefit , such patients ( SLL : 32 ; No SLL : 33 ) , defined as progression-free survival ( PFS ) < 6 months , were excluded from analysis . The adjusted relative risk of progression is 0.89 ( 95 % confidence interval : 0.75 , 1.07 ) ; the difference in median PFS is 1.0 month ( SLL : 23.9 months ; No SLL : 22.9 months ) . The survival rate curves are superimposable . CONCLUSION In the context of a non-r and omized comparison , the performance of a SLL was not associated with longer survival PURPOSE Conflicting results on prognostic factors for advanced epithelial ovarian cancer ( EOC ) have been reported because of small sample size and heterogeneity of study population . The purpose of this study was to identify factors predictive of poor prognosis in a similarly treated population of women with advanced EOC . PATIENTS AND METHODS A retrospective review of demographic , pathologic , treatment , and outcome data from 1,895 patients with International Federation of Gynecology and Obstetrics stage III EOC who had undergone primary surgery followed by six cycles of intravenous platinum/paclitaxel  was conducted . A proportional hazards model was used to assess the association of prognostic factors with progression-free survival ( PFS ) and overall survival ( OS ) . RESULTS Increasing age was associated with increased risks for disease progression ( HR = 1.06 ; 95 % CI , 1.02 to 1.11 for an increase every 10 years ) and death ( HR = 1.12 ; 95 % CI , 1.06 to 1.18 ) . Mucinous or clear-cell histology was associated with a worse PFS and OS compared with serous carcinomas . Patients with performance status ( PS ) 1 or 2 were at an increased risk for recurrence compared with PS 0 ( HR = 1.12 ; 95 % CI , 1.01 to 1.24 ) . Compared with patients with microscopic residual disease , patients with 0.1 to 1.0 cm and > 1.0 cm residual disease had an increased risk of recurrence ( HR = 1.96 ; 95 % CI , 1.70 to 2.26 ; and HR = 2.36 ; 95 % CI , 2.04 to 2.73 , respectively ) and death ( HR = 2.11 ; 95 % CI , 1.78 to 2.49 ; P < .001 ; and HR = 2.47 ; 95 % CI , 2.09 to 2.92 , respectively ) . CONCLUSION Age , PS , tumor histology , and residual tumor volume were independent predictors of prognosis in patients with stage III EOC . These data can be used to identify patients with poor prognosis and to design future tailored r and omized clinical trials Background The role of cytoreductive surgery in relapsed ovarian cancer is not clearly defined . Therefore , patient selection remains arbitrary and depends on the center ’s preference rather than on established selection criteria . The Descriptive Evaluation of preoperative Selection KriTeria for OPerability in recurrent OVARian cancer ( DESKTOP OVAR ) trial was undertaken to form a hypothesis for a panel of criteria for selecting patients who might benefit from surgery in relapsed ovarian cancer . Methods The DESKTOP trial was an exploratory study based on data from a retrospective analysis of hospital records . Twenty-five member institutions of the Arbeitsgemeinschaft Gynaekologische Onkologie Ovarian Committee ( AGO OC ) and AGO-OVAR boards collected data on their patients with cytoreductive surgery for relapsed invasive epithelial ovarian cancer performed in 2000–2003 . Results Two hundred and sixty-seven patients were included .  Complete resection was associated with significantly longer survival compared with surgery leaving any postoperative residuals [ median 45.2 vs. 19.7 months ; hazard ratio ( HR ) 3.71 ; 95 % confidence interval ( CI ) 2.27–6.05 ; P < .0001 ] . Variables associated with complete resection were performance status ( PS ) [ Eastern Cooperative Oncology Group ( ECOG ) 0 vs. > 0 ; P < .001 ] , International Federation of Gynecology and Obstetrics ( FIGO ) stage at initial diagnosis ( FIGO I/II vs. III/IV , P = .036 ) , residual tumor after primary surgery ( none vs. present , P < .001 ) , and absence of ascites > 500 ml ( P < .001 ) . A combination of PS , early FIGO stage initially or no residual tumor after first surgery , and absence of ascites could predict complete resection in 79 % of patients . Conclusions Only complete resection was associated with prolonged survival in recurrent ovarian cancer . The identified criteria panel will be verified in a prospect i ve trial ( AGO-DESKTOP II ) evaluating whether it will render a useful tool for selecting the right patients for cytoreductive surgery in recurrent ovarian cancer OBJECTIVE The aim of the study was to evaluate the effect of additional radiotherapy after chemotherapy on the relapse-free and overall survival rates of patients with advanced ovarian cancer . METHODS Between 1985 and 1992 64 patients with radically operated ovarian cancers ( 4 stage IC , 2 stage II , 54 stage III , and 4 stage IV ) were enrolled in a r and omized study . Radical surgery comprised total abdominal hysterectomy and bilateral salpingo-oophorectomy , omentectomy , and pelvic and paraaortic lymphadenectomy . All patients received adjuvant chemotherapy with carboplatin IV 400 mg/m2 , epirubicin IV 70 mg/m2 on day 1 and prednimustine orally 100 mg/m2 on days 3 to 7 at 1-month intervals . Thirty-two patients without residual disease were r and omized to whole abdominal radiation ( 30 Gy , administered over 4 weeks ) . An additional 21.6 Gy were delivered to the pelvis and 12 Gy to the paraaortic region up to the diaphragm for total doses of 51.6 and 42 Gy , respectively . Cancer-related survival was calculated with the Kaplan-Meier and Cox proportional hazards methods . RESULTS The relapse-free and overall survival rates of patients who received adjuvant chemoradiotherapy were significantly higher than those of patients who received adjuvant chemotherapy only ( 68 % vs 56 % at 2 years and 49 % vs 26 % at 5 years , P = 0.013 , and 87 % vs 61 % at 2 years and 59 % vs 33 % at 5 years , P = 0.029 ) . The differences were most pronounced in patients with stage III disease ( 77 % vs 54 % at 2 years and 45 % vs 19 % at 5 years , P = 0 . 0061 , and 88 % vs 58 % at 2 years and 59 % vs 26 % at 5 years , P = 0 . 012 ) . Toxicities were acceptable . CONCLUSION Sequential combination of platinum-based chemotherapy with open-field abdominal radiotherapy is a promising adjuvant regimen for patients with advanced ovarian cancer PURPOSE Epithelial ovarian cancer is the fourth leading cause of cancer-related death in women .  Five-year survival is about 25 % , and new approaches to the treatment of this disease are dearly warranted . This study was design ed to determine the feasibility of using an in vitro assay for drug resistance to guide treatment after cytoreductive surgery . We present preliminary results of this study after a median follow-up of 24 months . MATERIAL S AND METHODS We treated 66 patients with advanced ovarian cancer by use of a combination of cytoreductive surgery and chemotherapy . Patient inclusion criteria included histologic confirmation of epithelial ovarian cancer , International Federation of Gynecology and Obstectrics ( FIGO ) stage III , no prior chemotherapy or radiation therapy , no coexisting neoplasm , and optimal residual disease ( < 2 cm ) . Malignant tissue from the involved ovary of each patient was tested in vitro for drug resistance , and chemotherapy was directed individually by assay results . On the basis of the assay we treated 19 patients with platinum/paclitaxel ( TP ) and 47 with platinum/cyclophosphamide ( CP ) .  RESULTS Three-year survival ( Kaplan-Meier estimate ) was 69 % ; the 95 % confidence interval was 58 % to 80 % . There was no difference in 3-year survival between the 19 patients treated with TP ( 66 % ) and the 47 patients treated with CP ( 74 % ) . The cost-effectiveness of each treatment option was determined . It cost $ 4615 to achieve 3-year survival for patients receiving CP and $ 17,988 to obtain a similar survival with TP . The cost-effectiveness of assay-directed therapy was $ 9768 . DISCUSSION Because of the high recurrence rate and the poor long-term survival of women with advanced ovarian cancer , improved therapies for this disease are needed . After surgical debulking , we used results of an in vitro assay for drug resistance to individually select chemotherapy for the patients in this study . Although the 3-year survival of 69 % obtained in the present study appears good compared with previously published studies of optimally debulked patients , the results must be viewed with caution . Patients were not r and omized , and differences in prognostic factors , such as tumor grade , patient age , and performance status , could account in part for the higher survival found in the current study compared with previously published studies . Treatment with either CP or TP result ed in equivalent 3-year survival . The cost to achieve 3-year survival with this protocol , including the cost of the drug resistance assay , was $ 9768 . We believe that consideration of costs avoided by the elimination of ineffective treatments , needless toxicity , and loss of quality of life would likely increase the cost-effectiveness of assay-directed therapy compared with conventional therapy . This study demonstrates that it is feasible to use an in vitro assay in routine clinical practice to eliminate ineffective chemotherapeutic agents The aim of this study was to compare laparoscopic and laparotomic surgical staging in patients with stage I epithelial ovarian cancer in terms of feasibility and safety . A retrospective chart review was undertaken of all patients with apparent stage I epithelial ovarian cancer who underwent laparoscopic ( laparoscopy group ) or laparotomic ( laparotomy group ) surgical staging at the Center for Uterine Cancer , National Cancer Center , Korea , between January 2001 and August 2006 . During the study period , 19 patients underwent laparotomic surgical staging and 17 patients underwent laparoscopic surgical staging .  No cases were converted from laparoscopy to laparotomy . The two groups were similar in terms of age , body mass index , procedures performed , number of lymph nodes retrieved , and operating time . The laparoscopy group had less estimated blood loss ( P= 0.001 ) , faster return of bowel movement ( P < 0.001 ) , and a shorter postoperative hospital stay ( P= 0.002 ) compared to the laparotomy group . Transfusions were required only in two laparotomy patients , and postoperative complications occurred only in four laparotomy patients . However , two patients with stage IA grade 1 and 2 disease in laparoscopy group had recurrence with one patient dying of disease . The accuracy and adequacy of laparoscopic surgical staging were comparable to laparotomic approach , and the surgical outcomes were more favorable than laparotomic approach . However , the oncologic safety of laparoscopic staging was not certain . This is the first report on the possible hazards of laparoscopic staging in early-stage ovarian cancer . In the absence of a large prospect i ve trial , this technique should be performed cautiously The Danish Ovarian Cancer Study Group registered 722 patients in stages III and IV during the period 1981–1986 . The material included 85 % of all ovarian cancer patients in the catchment area of the group and patients allocated to protocol as well as patients treated outside protocol s. Five and 10-year survival were : stage III 17 % , and 8 % , respectively ; and stage IV 4 % and 2 % . Patients allocated to protocol had a significantly better survival than patients not included in protocol s even when only patients younger than 70 years were compared . All non- protocol patients had a poorer prognosis irrespective of the reason for exclusion . Five-year survival for stage III protocol patients was 25 % vs. 9 % , for non- protocol patients younger than 70 years . The 10-year survival was 11 % and 4 % for stage III protocol and non- protocol patients , respectively . A multivariate analysis showed that residual tumor , age , stage , and performance status had prognostic value . In non protocol patients histologic grade had an additional marginal prognostic impact . In conclusion the study showed that the statement that long-term survival in advanced ovarian cancer has been increased could not be proven by comparison of survival from r and omized studies performed in the early eighties with survival of stage III and IV patients before the introduction of cisplatinum chemotherapy . It is necessary to consider survival of all patients , protocol and non- protocol in a geographically well-defined region for evaluation of survival improvement OBJECTIVE We investigated the influence of hospital and gynecologist level of specialization and volume on surgical results and on survival of ovarian cancer patients . METHODS Data were collected from 1077 ovarian cancer patients treated from 1996 to 2003 in a r and om sample of 18 Dutch hospitals .  Hospitals and gynecologists were classified according to specialization ( general , semi-specialized or specialized ) and by volume ( < or=6 , 7 - 12 , or > 12 cases/year ) . Outcomes were percentage of adequately staged and optimally debulked patients and length of overall survival . Data were analyzed using multivariable logistic regression ( surgical results ) and Cox regression ( survival ) . RESULTS The level of specialization and the volume of hospitals and of gynecologists were strongly related to the proportion of adequately staged patients ( adjusted odds ratio ( OR ) specialized hospitals 3.9 ( 95 % confidence interval ( CI ) 2.0 - 7.6 ) ; specialized gynecologists 9.5 ( 95 % CI 4.7 - 19 ) ) . Patients with stage III disease had a higher chance of optimal debulking when treated in specialized hospitals ( adjusted OR 1.7 ( 95 % CI 1.1 - 2.7 ) ) or by high volume gynecologists ( adjusted OR 2.8 ( 95 % CI 1.4 - 5.7 ) ) . Overall survival was best in patients treated in specialized hospitals and by high-volume gynecologists . CONCLUSION The specialization level of hospitals and the surgical volume of gynecologists positively influence outcomes of surgery and survival . Concentration of ovarian cancer care thus seems warranted The data from two prospect i ve r and omised phase III trials that were initiated by the West Midl and s Ovarian Cancer Study Group ( WMOCSG ) in 1981 and 1986 , recruiting 167 and 195 patients respectively , have been pooled and the survival patterns of the 362 patients treated for advanced epithelial ovarian cancer within clinical trials in the West Midl and s over the 10 year period ( 1981 - 91 ) have been explored . All patients had histologically proven epithelial ovarian cancer and all had residual disease after primary surgery , with the majority having stage III/IV disease . The primary treatment for all patients was debulking surgery followed by platinum-based chemotherapy . Eligible patients were further r and omised to undergo a second debulking operation . The main end point , survival , was assessed using Kaplan-Meier curves and the log-rank test . A Cox proportional hazards model identified performance status ( P = 0.002 ) , residual disease ( P = 0.005 ) and albumin level ( P = 0.04 ) as independent prognostic factors . A multivariate model to predict survival curves for patients with the best and worst prognoses was developed with predicted 5 year survival of 30 % and 3 % for those in the best and worst prognostic groups respectively . The identification of clinical interventions to improve outcome is an urgent matter since the prognosis for patients with advanced ovarian cancer remains poor Background . Ovarian cancer is the fifth most common cause of cancer‐related death in American women . The median age at diagnosis is about 62 years ; incidence rises rapidly after age 60 .  Pelvic examination has been the primary method for detection of ovarian carcinoma . It is insensitive for the detection of early disease , however : most women present with disease beyond the pelvis ( Stages III and IV ) and are not curable with existing techniques . Two new technologies may be useful as screening tools for earlier detection of ovarian cancer . CA 125 is an antigenic determinant expressed on an ovarian cancer cell line . Transvaginal ultrasound ( TVUS ) images the ovaries from within the vagina and can be performed by a technician in about 10 minutes . In small preoperative studies of women with ovarian masses , serum CA 125 levels have been elevated ( typically above 35 U/ml ) in over two‐thirds of cases and in up to 50 % of Stage I cases . The test is not absolutely specific : elevations have been reported with pregnancy , endometriosis , menstruation , benign ovarian tumors , and with cancers of the breast , colon , pancreas , lung , stomach , and liver . Nevertheless , the specificity of CA 125 in postmenopausal women has been reported at about 95 % or more . TVUS provides higher resolving power for ovarian abnormalities than transabdominal ultrasound or physical examination ; however , experience with it is limited . CA 125 and TVUS may be complementary Current accepted prognostic indicators in ovarian cancer include performance status , surgical ( FIGO ) staging , and residual disease after operation . Here we present data from a  prospect i ve analysis of patients with ovarian cancer treated at the Christie Hospital . We confirm the independent prognostic effects of FIGO staging , performance status , and residual disease in our group of patients and furthermore show that CA125 levels at presentation to the oncology service are of independent prognostic significance ( P= 0.02 ) . We present survival data and show that the 3-year , cancer-specific survival for stage I disease is 90 % . We postulate that this good survival may in part be due to the use of computed tomography scanning at presentation to allow accurate staging . Further clinical trials are needed to test whether combinations of surgical , histologic , biochemical , and radiologic parameters can be used to identify a population with such a good prognosis that adjuvant therapy is not required
In regards to surgery it is recommended to perform total omentectomy since subclinic metastasis have been documented in 10 - 30 % of all cases , and systematic limphadenectomy , necessary to be able to obtain an adequate surgical staging .
Minimal invasion surgery is not a recommended procedure for the treatment of advanced ovarian cancer .
Radiotherapy can be used to palliate symptoms .
In the present , there is not a st and ardized screening method .
Diagnosis in early stages means a better survival .
Radiotherapy can be indicated to palliate symptoms
INTRODUCTION Ovarian cancer ( OC ) is the third most common gynecologic malignancy worldwide .
Most of cases it is of epithelial origin .
At the present time there is not a st and ardized screening method , which makes difficult the early diagnosis .
The 5-year survival is 90 % for early stages , however most cases present at advanced stages , which have a 5-year survival of only 5 - 20 % .
GICOM collaborative group , under the auspice of different institutions , have made the following consensus in order to make recommendations for the diagnosis and management regarding to this neoplasia .
Until now , laparoscopy for diagnostic-staging surgery is not well known as a recommended method .
In advanced stages , primary cytoreduction is recommended as initial treatment .