The Medical-Surgical Nurse's Guide to Ovarian Cancer: Part II (original) (raw)

Laparoscopic Follow-Up of Patients with Ovarian Carcinoma

BJOG: An International Journal of Obstetrics and Gynaecology, 1980

Laparoscopy with cytology of ascitic fluid or peritoneal washings was performed on 110 occasions in 62 patients with ovarian cancer to assess response to chemotherapy. Damage to bowel occurred on three occasions and complete visualisation of the peritoneal cavity was not possible in 14 patients. When tumour was seen and/or cytology was positive, the prognosis was poor; absence of macroscopic tumour with negative cytology did not preclude continuing disease. A group of patients was identified in whom a change of therapy based on laparoscopic findings after six months of treatment, might have proven beneficial. Laparoscopy has a limited place as a second-look procedure in patients undergoing treatment for carcinoma of the ovary.

Is it the time for laparoscopic management of early-stage ovarian malignancies?

Gynecology and Minimally Invasive Therapy, 2018

Review Article IntroductIon Key successful treatment for ovarian cancer consists of appropriate surgical staging and optimal surgery. Surgical staging originally necessitated an exploratory laparotomy advised by the Federation of Obstetrics and Gynecology. Since the early 1980s, it has become evident that less-invasive methods of interventional treatment have produced far fewer complications with a reduced risk of morbidities such as decreased blood loss, faster recovery, and shorter hospital stay. Minimally invasive surgery has become increasingly popular and performed extensively. Over the past decade, laparoscopic approach to cancer therapy has been adopted by gynecologic oncologists for the treatment of early-stage endometrial and cervical cancer. This approach offers a means to decrease the morbidity associated with open surgery without compromising oncologic outcome. [1-6] However, the acceptance of laparoscopy for surgical staging women with ovarian cancer remains controversial. Questions remain about the adequacy, feasibility, and standardization of laparoscopic technique, the possible risks of tumor metastases, and impact on survival outcome. The latest review reported that there was insufficient evidence to evaluate laparoscopy for the management of early-stage ovarian cancer as routine clinical practice. Taking into consideration the lack of high-quality evidence, the laparoscopic approach in the early-stages of ovarian cancer seems safe and effective. In this communication, we reviewed the use of laparoscopy in the management of early-stage ovarian cancer to clarify the outcome and to provide further guidance for optimal management. Methods We included studies those provided the feasibility, adequacy, and outcome of the patient with early-stage ovarian cancer after laparoscopic surgical staging. The articles cited were The laparoscopic management of early-stage ovarian cancer remains controversial. Some surgeons hesitate to perform laparoscopic staging due to concern with the adequacy of staging, the possibility of tumor spillage and risk of port-site metastasis. Previous studies and literature reviews have reinforced the argument and supported the use of laparoscopy. However, the results were drawn with limited sample size obtained from case-series and case-control studies which result in difficult to make definite conclusions. Till date, the list of laparoscopic procedures has grown at a pace consistent with improvements in technology and technical skill of the surgeon. The number of studies with larger sample size, more prospective data, and longer duration of follow-up has been increasing. This review serves as an update on safety, feasibility, surgical, and oncological outcomes in cases of early-stage ovarian cancer treated by laparoscopic surgery of the literature published since 2008. We aim to clarify whether laparoscopy is safe and effective enough to be considered as standard management. Rely on nonrandomize studies, the current clinical evidence supports the role of laparoscopy in the management of early-stage ovarian cancer. Laparoscopy appears to offer several perioperative benefits without compromise of surgical morbidity and oncological outcome.

Laparoscopic Treatment and Staging of Early Ovarian Cancer

Journal of Minimally Invasive Gynecology, 2008

To review the laparoscopic staging procedure in a series of patients with early ovarian cancer and compare results with the literature. Design: A prospective single-center study (Canadian Task Force classification II-2). Setting: A hospital in Spain. Patients: A total of 20 patients with apparent early stage ovarian cancer from January 2003 through November 2007. The histologic tumor types were epithelial tumors (18 patients) and dysgerminoma (2 patients). Among the epithelial tumors, 11 were invasive and 7 were borderline (3 serous and 4 mucinous). Interventions: Comprehensive laparoscopic staging was performed in all patients according to the International Federation of Gynecology and Obstetrics guidelines. Measurements and Main Results: Seventeen patients had previous adnexal surgery and diagnosis and surgical staging were performed in only 3 patients during the same surgery. The patients' median age was 42.8 years (range 16-67). Eight (40%) patients desired to maintain fertility and a conservative approach was performed for this group. Laparoscopic staging was completed in 19 (95%) patients. In 1 case, a conversion to laparotomy was necessary as the para-aortic lymphadenectomy was completed because of a vessel lesion that was repaired without difficulty. The median operative time was 223 minutes (range 180-320) for radical surgery and 188 minutes (range 120-240) for the conservative approach. The mean hospital stay was 3 days. Of the 20 total patients, 4 (20%) were upstaged. The median follow-up was 24.7 months (range 1-61), with a disease-free survival of 95% and an overall survival of 100%. One recurrence was observed. Conclusion: A comprehensive surgical staging procedure is clearly indicated in cases of early ovarian cancer and oncologic guidelines should be respected. The laparoscopic approach could be a valid alternative to laparotomy.

The value of surgery in ovarian cancer

The Obstetrician & Gynaecologist, 2000

The value of surgery in ovarian cancer sies or laparoscopy)! the more routine approach is :I laparotomy to obtain tissue for histological confirmation of disease, to permit staging and for excision of all macroscopic tumour (Figwe 1). The criteria for staging arc indicated within the FIG0 staging system. Tsahdina E, v[~olkis lU? Cfiitcr PG, el MI. tixsuutomy tubes in patients n-it11 recurrent gynaecological caiicfr a d intestinal obstruction. Br.7

Surgical procedures for ovarian cancer

Annals of the Royal College of Surgeons of England, 1986

The management of 191 patients with ovarian cancer is presented. A significant proportion of these patients were initially seen (16%) or operated on (7%) by a general surgeon. The current surgical approach to this disease should be aggressive, and in 23% of these patients a non-gynaecological surgical procedure was required. Although chemotherapy is the main form of treatment following surgery, its chances of success are influenced by the amount of tumour left after surgery. The picture is not uniformly hopeless, and of 34 patients who subsequently underwent laparotomy to check the effectiveness of chemotherapy, 10 (29%) had no evidence of disease. Palliative surgery also has an important place in the management of this disease to provide comfort from disabling symptoms, and in some cases it may prolong life.

Laparoscopic Surgery in Cases of Ovarian Malignancies: An Austria-wide Survey

Gynecologic Oncology, 1996

management of 1011 women with adnexal masses. The The purpose of the study was to determine the frequency of AAGL 1990 Survey reported an overall incidence for stage discovering a malignant ovarian mass when laparoscopy is used I ovarian cancer of 4 per 1000 cases when performing operato manage an adnexal mass. A countrywide survey was undertaken tions on persistent ovarian tumors [10]. These AAGL data in Austria, comprising questions about ovarian malignancy derepresent the results of 13,739 laparoscopic procedures pertected or accidentally treated by laparoscopy. The response rate formed during 1990 for ovarian masses, one of the most of 66.7% represented a total of 54,198 laparoscopies, 16,601 laparofrequent indications for laparoscopic surgery; however, no scopic surgeries on adnexal masses, and 108 cases of ovarian tupatient-specific data are presented in this article [10]. Theremors subsequently found to be malignant (96 well-documented).

The Role of Minimally Invasive Surgery in Ovarian Cancer

International Journal of Gynecologic Cancer, 2013

The standard treatment of ovarian cancer includes upfront surgery with intent to accurately diagnose and stage the disease and to perform maximal cytoreduction, followed by chemotherapy in most cases. Surgical staging of ovarian cancer traditionally has included exploratory laparotomy with peritoneal washings, hysterectomy, salpingo-oophorectomy, omentectomy, multiple peritoneal biopsies, and possible pelvic and para-aortic lymphadenectomy. In the early 1990s, pioneers in laparoscopic surgery used minimally invasive techniques to treat gynecologic cancers, including laparoscopic staging of early ovarian cancer and primary and secondary cytoreduction in advanced and recurrent disease in selected cases. Since then, the role of minimally invasive surgery in gynecologic oncology has been continually expanding, and today advanced laparoscopic and roboticassisted laparoscopic techniques are used to evaluate and treat cervical and endometrial cancer. However, the important question about the place of the minimally invasive approach in surgical treatment of ovarian cancer remains to be evaluated and answered. Overall, the potential role of minimally invasive surgery in treatment of ovarian cancer is as follows: i) laparoscopic evaluation, diagnosis, and staging of apparent early ovarian cancer; ii) laparoscopic assessment of feasibility of upfront surgical cytoreduction to no visible disease; iii) laparoscopic debulking of advanced ovarian cancer; iv) laparoscopic reassessment in patients with complete remission after primary treatment; and v) laparoscopic assessment and cytoreduction of recurrent disease. The accurate diagnosis of suspect adnexal masses, the safety and feasibility of this surgical approach in early ovarian cancer, the promise of laparoscopy as the most accurate tool for triaging patients with advanced disease for surgery vs upfront chemotherapy or neoadjuvant chemotherapy, and its potential in treatment of advanced cancer have been documented and therefore should be incorporated in the surgical methods of every gynecologic oncology unit and in the training programs in gynecologic oncology.

Laparoscopy Versus Laparotomy for The Staging of Early Stage Ovarian Cancer: Surgical Outcomes

Background: There is no evidence-based data evaluating the profits and harms of laparoscopy for the surgical treatment of early stage ovarian cancer. Objective: To compare the surgical and oncological outcomes between laparoscopy and laparotomy staging for early-stage ovarian cancer. Methods: This case-control study consisted of 15 women undergoing comprehensive laparoscopic surgical staging (LPS group) for apparently EOC. The control group included 15 women who underwent surgical staging by traditional open laparotomy (LPT group). Demographic data, detailed surgical procedures data, and all intra and postoperative details were documented and compared in between both groups. Results: Our results showed no difference in the basic patients characteristics and preoperative variables in between both groups. Operative time was significantly longer (P=0.005), and the amount of blood loss was higher in the LPT group (P=0.025). Intraoperative rupture of the ovarian mass happened in 3 (20%) cases in the LPS group and in 2 (13.3%) cases in the LPT group (P=0.531). Conversion to laparotomy has been done in 2 cases (13.3%). There was no other reported intraoperative complication in the LPS group. Following the procedure, the time needed for initiation of diet was nearly equal (P=0.457). While, the time needed for drain removal and the mean hospital stay were longer in the LPT group compared with the LPS group (P=0.048 and <0.001 respectively). Limitation: small sample size and lack of follow-up period. Conclusion: In early stage ovarian cancer, laparoscopic staging achieved by a well-trained, skilled surgeon has comparable surgical outcomes to laparotomy.