Prediction of Surgical Outcome in Advanced Ovarian Cancer by Imaging and Laparoscopy: A Narrative Review
Abstract
Maximal-effort debulking surgery is the recommended approach for advanced-stage ovarian cancer. The role of imaging is to provide a preoperative systematic and structured report of tumour dissemination with special emphasis on key sites that preclude optimal resectability in ovarian cancer surgery.
Imaging methods cannot reliably detect small volume carcinomatosis but yield high diagnostic performance for detecting bulky disease at critical sites for cytoreduction and can thus be reliably used to avoid unnecessary explorations. Although diagnostic laparoscopy may directly visualize intraperitoneal involvement, it has inherent limitations when investigating tumours behind the gastrosplenic ligament, in the lesser sac, mesenteric root or when exploring the retroperitoneum.
The major benefit of laparoscopy appears as an ultimate triage step in situations where the imaging diagnosis is uncertain regarding resectability and the presence of diffuse small-volume carcinomatosis.