Fluorescence-Guided Surgery to Detect Microscopic Disease in Ovarian Cancer: A Systematic Review with Meta-Analysis

Area of Science:

• Gynecologic Oncology
• Surgical Innovation
• Medical Imaging

Background:

• Maximal cytoreduction is key in epithelial ovarian cancer surgery, but current methods struggle to detect microscopic disease.
• Microscopic disease may drive recurrence and chemoresistance in ovarian cancer.
• Fluorescence-guided surgery (FGS) is an emerging technique with limited evaluation in ovarian cancer.

Purpose of the Study:

• To systematically review and evaluate FGS techniques for detecting microscopic ovarian cancer.
• To compare the efficacy of FGS with total peritonectomy in identifying residual disease.
• To assess the diagnostic accuracy and safety of different fluorescence agents.

Main Methods:

• Systematic literature search across PubMed, Web of Science, and Embase (1975-2024).
• Inclusion of randomized controlled trials and observational studies on ovarian cancer patients undergoing FGS or total peritonectomy.
• Data synthesis using PRISMA and MOOSE guidelines, calculating sensitivity, specificity, and positive predictive value (PPV).

Main Results:

• Twelve studies involving 429 patients were analyzed.
• FGS improved microscopic disease detection (pooled sensitivity 0.77) compared to standard methods.
• 5-aminolevulinic acid (5-ALA) demonstrated high diagnostic accuracy (sensitivity 84%, specificity 96%), while folate receptor-targeted agents showed lower specificity.
• Total peritonectomy did not offer an advantage over FGS for microscopic disease detection.
• Reported adverse events were mild.

Conclusions:

• Fluorescence-guided surgery, particularly with 5-ALA, shows potential for improving microscopic disease detection in ovarian cancer surgery.
• FGS may alter surgical management, but further research is needed due to heterogeneity and limited survival data.
• Total peritonectomy does not enhance the detection of microscopic disease compared to FGS.