Impact of diagnostic laparoscopy on resectability and treatment strategy in FIGO III-IV ovarian cancer.

Abstract

Objective: To investigate the clinical utility of diagnostic laparoscopy in guiding treatment strategy and surgical outcomes for patients with advanced-stage ovarian cancer, specifically regarding operability assessment and the likelihood of complete cytoreduction.

Methods: This retrospective cohort study analyzed 183 patients with histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stage III-IV ovarian cancer treated with curative intent between January 2018 and December 2023 at a tertiary referral center. Patients were divided into two groups: those who underwent diagnostic laparoscopy prior to primary treatment (n = 80) and those managed without laparoscopy (n = 103). Laparoscopy was selectively employed when operability was uncertain. The primary outcome was the rate of complete macroscopic tumor resection. Secondary endpoints included intraoperative inoperability, neoadjuvant chemotherapy (NACT) rates, and surgical complexity. Statistical analyses included chi-square tests and predictive value calculations.

Results: Complete macroscopic resection was achieved in 57.5% of patients in the laparoscopy group compared to 68.0% in the control group. Among FIGO III cases, complete resection was lower in the laparoscopy group (63.0% vs. 77.0%), while rates were similar for FIGO IV (53.8% vs. 54.8%). Diagnostic laparoscopy had a positive predictive value of 59% and was a statistically significant, albeit weak, predictor of operability (p = 0.003, phi = 0.13). Patients in the laparoscopy group were more frequently triaged to NACT (78.8% vs. 50.5%). Intraoperative inoperability was also higher (29% vs. 14%).

Conclusion: Diagnostic laparoscopy influenced treatment strategy by increasing NACT use and reducing non-beneficial surgeries. Though it did not improve overall cytoreduction rates, it enabled personalized treatment planning, especially in patients with ambiguous resectability, thereby potentially lowering surgical morbidity.