J Gynecol Oncol.  2024 Mar;35(2):e14. 10.3802/jgo.2024.35.e14.

Feasibility of laparoscopic VisceralPeritoneal Debulking (L-VPD) in patients with stage III–IV ovarian cancer: the ULTRA-LAP trial pilot study

• Tozzi R
• Noventa M
• Saccardi C
• Spagnol G
• Tommasi OD
• Coldebella D
• Marchetti M

• KMID: 2564874
• DOI: http://doi.org/10.3802/jgo.2024.35.e14

Abstract

Objective
A non-randomized prospective clinical trial (ULTRA-LAP) was registered to test safety, side effects and efficacy of laparoscopic Visceral-Peritoneal Debulking (L-VPD) in patients with stage III–IV ovarian cancer (OC). A pilot study was designed to identify which OC patients are suitable to undergo L-VPD.
Methods
Between March 2016 and October 2021, all consecutive patients with OC underwent exploratory laparoscopy (EXL). All patients whose disease was deemed amenable for a complete resection (CR) at imaging review and EXL, underwent VPD. In all patients a consistent attempt was made at completing L-VPD.
Results
Two hundred and eight OC had EXL in the study period: 121 underwent interval VPD and 87 up-front VPD. Overall, 158 patients had VPD by laparotomy (75.9%) and 50 (24.1%) had L-VPD, of which 34 patients as interval (iL-VPD) and 16 as up-front (uL-VPD). Intra- and post-operative morbidity was very low in the L-VPD group. CR rate was 98% in L-VPD group and 94% in VPD. Most common reason for conversion was diaphragmatic disease extending dorsally.
Conclusion
In the pilot study of ULTRA-LAP, L-VPD was completed in 24,1% of OC. Initial analysis supports the feasibility of L-VPD in 2 groups of OC: those with no gross disease at interval surgery and those with gross visible disease at upfront or interval surgery, but limited to: pelvis (including recto-sigmoid), gastro colic omentum, peritoneum and diaphragm, the latter not requiring dorsal liver mobilization. Both groups had 100% feasibility and have been thus forth recruited to ULTRA-LAP.

Keyword

Ovarian Cancer; Visceral-Peritoneal Debulking; Laparoscopic Debulking; Minimally Invasive Debulking Surgery