The role of exploratory laparoscopy in surgical planning for ultra- radical surgery for ovarian cancer: a narrative review

Objectives: The aim of this narrative review is to summarise the available evidence on the use of staging laparoscopy (S-LPS) in the pre-operative management of advanced epithelial ovarian cancer (EOC). Background: EOC presents at an advanced stage in most women and is often characterised by extensive intraperitoneal spread. One of the main treatment goals in these patients is to determine the best therapeutic strategy: primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Identifying who can benefit from NACT can help optimise oncological management and avoid inappropriate upfront laparotomies. The role of S-LPS in clinical practice has increased significantly worldwide as a pre-operative tool for the management of advanced EOC. Methods: An electronic database search was performed on PubMed, Medline, and Google Scholar for relevant studies from inception to February 2021. Conclusions: S-LPS represents a safe and adequate procedure for the staging of advanced EOC in combination with CT imaging, and is associated with a shorter length of hospital stay and time to start systemic therapy. Particularly in centres with a high cytoreduction rate, S-LPS, in conjunction with CT-scan, could represent a useful diagnostic combination for the pre-operative surgical planning, along with allied multidisciplinary teams. The main concerns relate to inadequate retroperitoneal staging. However, it is a cost-effective procedure that also reduces the complications associated with futile laparotomies.