Laparoscopy For Staging Early Ovarian & Fallopian Tube Cancer?
Monday December 8, 2008
A recent e-publication from New York, from Dr.Nezhat and company, sparked my interest for a commentary. Dr.Nezhat and colleagues, who are known for minimally invasive surgery, have restated what may be the obvious in this day and age.
The group reviewed 36 patients over a 12 year period (1995-2007), noting that it was feasible to perform the usual staging procedures laparoscopically in early cancers, including lymph node sampling, peritoneal biopsies and removal of part of the omentum. The complication rate was moderate, but not life threatening and, the most important factor, 7 of the 36 were upstaged. This means disease was found outside of the ovary and lifesaving treatment added, although three have suffered a recurrence as of the publication date.
The conclusion of the study is that laparoscopic surgery in this situation is effective and does not compromise survival, as long as it is performed by an experienced gynecologic oncologist who is expert in minimally invasive surgery. Although seemingly small, this is one of the larger studies which have long-term follow-up.
I would comment that, although some randomized studies are still underway, we have enough cumulative experience to say that minimally invasive surgery should be considered as today's standard.....or at least offered as an option in many, if not all, cases. Of course there would be dissenting opinions. However, most of those would be from those who do not perform laparoscopy in their oncologic practice.
My personal use of laparoscopy in these situations dates back to the 80's, much of which went unpublished, and many of my colleagues also have reams of unpublished experience. Laparoscopy is simply an instrument, a tool, and in the right hands is quite effective. The upside is what we all know.....MUCH faster recovery. The downside? Not much, although each patient's situation is different. Regardless, it is something to discuss with your physician in the event you are suspected to have early ovarian cancer.
As usual, comments welcomed and encouraged....
The group reviewed 36 patients over a 12 year period (1995-2007), noting that it was feasible to perform the usual staging procedures laparoscopically in early cancers, including lymph node sampling, peritoneal biopsies and removal of part of the omentum. The complication rate was moderate, but not life threatening and, the most important factor, 7 of the 36 were upstaged. This means disease was found outside of the ovary and lifesaving treatment added, although three have suffered a recurrence as of the publication date.
The conclusion of the study is that laparoscopic surgery in this situation is effective and does not compromise survival, as long as it is performed by an experienced gynecologic oncologist who is expert in minimally invasive surgery. Although seemingly small, this is one of the larger studies which have long-term follow-up.
I would comment that, although some randomized studies are still underway, we have enough cumulative experience to say that minimally invasive surgery should be considered as today's standard.....or at least offered as an option in many, if not all, cases. Of course there would be dissenting opinions. However, most of those would be from those who do not perform laparoscopy in their oncologic practice.
My personal use of laparoscopy in these situations dates back to the 80's, much of which went unpublished, and many of my colleagues also have reams of unpublished experience. Laparoscopy is simply an instrument, a tool, and in the right hands is quite effective. The upside is what we all know.....MUCH faster recovery. The downside? Not much, although each patient's situation is different. Regardless, it is something to discuss with your physician in the event you are suspected to have early ovarian cancer.
As usual, comments welcomed and encouraged....