Debate 12B - Should Laparoscopic Modalities be Routinely Utilized for Assessment of Resectability prior to Attempted Primary Debulking in Patients with Advanced Ovarian Cancer?

Summary

The decision to proceed with primary debulking surgery is complex and depends on multiple factors including patient (age, performance, and nutrition status), center (surgeon/team expertise, volume, ancillary services) and disease factors. Routine laparoscopy has been proposed to assess disease factors: specifically, extent of disease and complexity of surgery required for successful resection. However, laparoscopy requires additional OR time and equipment, lacks sensitivity, and does not accurately assess several of the most agreed upon barriers to successful cytoreduction. Standardized laparoscopic scoring systems have demonstrated high specificity to predict suboptimal debulking, but primarily in single institution studies. These systems are difficult to validate externally, likely due to differing non-disease-related factors. We favor a multi-modality approach beginning with careful patient and center selection and pre-operative imaging. Suitable candidates then undergo exploration via mini-laparotomy at the time of planned debulking surgery to minimize morbidity while maximizing oncologic outcomes.