paywalled - Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer

Gynecologic Oncology - Video-assisted thoracic surgery (VATS) evaluation of intrathoracic disease in patients with FIGO III and IV stage ovarian cancer

Purchase

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Abstract

Introduction

The aim of this study was to assess the influence of video-assisted thoracic surgery (VATS) on our treatment decisions in FIGO III and IV ovarian cancer patients.

Highlights

► Preoperative chest CTs is not an appropritate staging tool for the evaluation of intrathoracic tumorload in advanced Ovarian Cancer patients
► Video-assisted thoracic surgery can be performed quickly and safely before deciding about primary cytoreduction or neodadjuvant chemotherapy in advanced Ovarian Cancer patients

Methods and patients

Patients with ovarian cancer and suspected supra-diaphragmatic involvement (pleural effusions, pleural carcinomatosis, lung metastasis, or enlarged supra-diaphragmatic lymph nodes) at chest computer tomography (CT) scan underwent VATS with or without laparoscopy (LSC) to decide for primary cytoreduction or neoadjuvant chemotherapy. Operation time, VATS complications (intrapleural hematoma, secondary hemorrhage with intervention, pneumonia, empyema) and shift in the therapeutic strategy due to VATS were evaluated.

Results

17 patients were included into this study (1 patient with FIGO stage IIIb, 1 with IIIc and 15 with stage IV). The median operation time for VATS only was 46.5 minutes (range: 20 – 50 min, n = 3). Perioperatively, no complications occurred. After surgical staging, the tumor was confined to the abdomen in four patients in whom primary cytoreduction was attempted. All other 13 patients underwent neoadjuvant chemotherapy. VATS altered the therapeutic management in 6/17 ovarian cancer patients (3 times upstaging, 3 times downstaging). Negative predictive values (NPV) for local and diffuse pleural carcinomatosis ranged between 0.5 and 0.71.

Discussion

In this case series, VATS in addition to LSC showed negligible morbidity related to surgery and a short operation time. We were able to improve the accuracy of the FIGO staging and assessed operability more reliably in these patients than through imaging techniques alone.

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Highlights

► Preoperative chest CTs is not an appropritate staging tool for the evaluation of intrathoracic tumorload in advanced Ovarian Cancer patients ► Video-assisted thoracic surgery can be performed quickly and safely before deciding about primary cytoreduction or neodadjuvant chemotherapy in advanced Ovarian Cancer patients

Keywords

• Ovarian cancer;
• Thoracic staging;
• Video assisted thoracic surgery