J Casarin, A Giudici, G Schivardi, T Meschini, F Multinu, G Bogani, A M Perrone, N Bizzarri, S Di Berardino, G Ricotta, T Bianchi, M Gracia Segovia, M Del, F Martinelli, F Saner, I Zapardiel, P De Iaco, F Raspagliesi, F Landoni, M Mueller, G Ferron, V Zanagnolo, A Martinez, G Aletti, D Lorusso, F Ghezzi, A Fagotti
Minimally invasive surgery is a valuable approach for early-stage ovarian cancer staging in specialized centers, achieving survival outcomes comparable to those reported in the literature for open surgery. Our findings support an individualized approach to retroperitoneal staging and suggest that intra-operative capsule rupture alone may have limited prognostic relevance.
OBJECTIVE: To evaluate oncologic outcomes of minimally invasive surgery in patients with apparent early-stage epithelial ovarian cancer treated in European referral centers.
METHODS: The study, a retrospective evaluation of minimally invasive surgical strategies in ovarian neoplasms, is a retrospective multi-center cohort study evaluating oncologic outcomes of minimally invasive surgery for apparent early-stage epithelial ovarian cancer in 10 European referral centers (01/2014 to 12/2023). Clinical, surgical, pathological, adjuvant treatment, and follow-up data were collected using a standardized database. The primary endpoint was disease-free survival. Secondary endpoints included recurrence patterns and the impact of retroperitoneal staging and intra-operative capsule rupture on oncologic outcomes.
RESULTS: A total of 612 patients were included; 49.8% underwent primary staging. Upstaging occurred in 48.7%. Retroperitoneal staging was performed in 78.3%, with lymph node metastasis in 9.6%, most frequently in serous tumors (15.3%, p < .001). Overall, 81 patients (13.2%) recurred, predominantly peritoneally (71.6%). Five-year disease-free survival was 82.3% (95% confidence interval 77.7% to 86.1%). Retroperitoneal staging did not significantly impact disease-free survival in high-grade (p = .41) or low-grade tumors (p = .29). Intra-operative capsule rupture occurred in 26.6% of stage I patients undergoing primary surgery and was not associated with worse disease-free survival (Hazard ratio 0.92, 95% confidence interval 0.38 to 2.20, p = .85). Adjuvant chemotherapy was administered to 68.3% and more frequently after retroperitoneal staging (73.9% versus 48.1%, p < .001), particularly in low-grade tumors (50.0% versus 29.9%, p = .01).
CONCLUSIONS: Minimally invasive surgery is a valuable approach for early-stage ovarian cancer staging in specialized centers, achieving survival outcomes comparable to those reported in the literature for open surgery. Our findings support an individualized approach to retroperitoneal staging and suggest that intra-operative capsule rupture alone may have limited prognostic relevance.