Minimally invasive interval debulking surgery in advanced ovarian cancer: a real-life PICture of pAtientS’ SelectiOn

AbstractObjectiveThis study aimed to assess the accuracy of pre-operative computed tomography in identifying candidates for minimally invasive interval cytoreductive surgery after neoadjuvant chemotherapy in patients with advanced ovarian cancer.MethodsThis retrospective, single-center study included patients with advanced ovarian cancer who received 3 to 4 cycles of platinum-based neoadjuvant chemotherapy, followed by interval cytoreductive surgery, between July 2021 and May 2024. Pre-operative computed tomography scans were reviewed by expert radiologists to assess the extent and distribution of residual disease. Patients were deemed eligible or ineligible for minimally invasive interval cytoreductive surgery based on radiologic criteria. Computed tomography findings were compared with intra-operative findings to evaluate sensitivity, specificity, predictive values, and diagnostic accuracy. Site-specific concordance was assessed using Cohen’s κ.ResultsA total of 87 patients were included. Computed tomography scan demonstrated an overall accuracy of 71.3% (95% confidence interval 61.76 to 80.77) in predicting feasibility of minimally invasive interval cytoreductive surgery, with a sensitivity of 71.4% (95% confidence interval 52.11 to 90.75) and a specificity of 71.2% (95% confidence interval 60.29 to 82.14). False-negative and false-positive rates were 28.6% and 28.8%, respectively. Concordance between computed tomography and surgical findings was moderate (Cohen’s k = 0.35). The highest agreement was found for small bowel and mesenteric involvement, whereas diaphragmatic and perihepatic sites showed the lowest concordance.ConclusionsThis study shows that the radiologic selection process for minimally invasive interval cytoreductive surgery is complex. The not negligible false-negative and false-positive rates suggest that a combined approach, including diagnostic laparoscopy or advanced imaging tools, may improve surgical planning and patient selection for minimally invasive surgery at interval cytoreductive surgery.