Diagnostic Laparoscopy: A Way To Reduce Likelihood of Futile Laparotomy?

Treatment with diagnostic laparoscopy rather than primary surgery may lower the rate of futile laparotomies among women with suspected advanced ovarian cancer.
Treatment with diagnostic laparoscopy rather than primary surgery may lower the rate of futile laparotomies among women with suspected advanced ovarian cancer.

Treatment with diagnostic laparoscopy rather than primary surgery may lower the rate of futile laparotomies among women with suspected advanced ovarian cancer, according to a study published in the Journal of Clinical Oncology.1

Researchers conducted a multicenter, randomized controlled trial of 201 patients; each was randomly assigned to either diagnostic laparoscopy or primary surgery to determine whether laparoscopy would prevent unnecessary primary cytoreductive surgery (PCS) among patients who would still have residual disease greater than 1 cm after treatment.

In total, 63 of 102 patients (62%) who were assigned to diagnostic laparoscopy underwent PCS compared to 93 of 99 (94%) of patients who were assigned to primary surgery. Futile laparotomy occurred in 10% of cases in the laparoscopy group and in 39% of cases in the primary surgery group.

Three patients (3%) in the laparoscopy group had undergone both primary and interval surgery compared to 28 patients (28%) who had undergone primary surgery.

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“In women with a plan for PCS, these data suggest that performance of diagnostic laparoscopy first is reasonable that if cytoreduction to less than 1 cm of residual disease seems feasible, to proceed with PCS,” the authors concluded.

Reference

  1. Rutten MJ, van Meurs HS, van de Vrie R, et al. Laparoscopy to predict the result of primary cytoreductive surgery in patients with advanced ovarian cancer: a randomized controlled trial. J Clin Oncol. 2016 Dec 28. doi: 10.1200/JCO.2016.69.2962 [Epub ahead of print]
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