Debate 12A - Should Minimally Invasive Modalities be Routinely/Uniformly Utilized for Assessment of Resectability prior to Attempted Primary Debulking in Patients with Advanced Ovarian Cancer?

Summary

Ovarian cancer consistently remains the most lethal gynecologic malignancy because it is predominantly found at an advanced stage. Often, despite efforts to ascertain the potential for successful surgical resection based on imaging, clinical symptomatology, and serum CA-125, it is frequently not determined until the time of surgery with widespread metastasis throughout the peritoneal cavity that was not seen on standard axial imaging. Secondary to the possibility of this “ineffective” or “unnecessary” laparotomy only to discover unresectable cancer, the implementation of diagnostic laparoscopy to determine the extent of the disease and the ability to perform a complete cytoreductive surgery has been adapted by some surgeons. Though data is varied as to the effectiveness of laparoscopy to determine the resectability of advanced ovarian cancer, it adds another layer of diagnostic information through a minimally invasive modality and ultimately prevents patients who are deemed unresectable from going through an invasive, painful procedure that often requires at least a single-day postoperative hospitalization and could delay the initiation of neoadjuvant chemotherapy if there are postoperative complications.