Minimally invasive surgery in advanced and recurrent ovarian cancer: current evidence and future directions

The use of minimally invasive surgery (MIS) in advanced ovarian cancer management following neoadjuvant chemotherapy yields potential benefits in patient recovery and quality of life compared with traditional open surgery. MIS techniques, including robot-assisted procedures, have been increasingly utilized in recent years despite ongoing debates about their oncologic safety.

Recent prospective and retrospective studies indicate that MIS for interval debulking after neoadjuvant chemotherapy can achieve similar cytoreductive outcomes (no visible residual disease, CC-0) to laparotomy in carefully selected patients. Key reported advantages include reduced perioperative morbidity, lower blood loss, and shorter hospital stays. Nonetheless, current data are limited by patient selection bias, power of the studies to detect differences, and concerns about accurately detecting small-volume disease laparoscopically. Ongoing randomized controlled trials, such as the LANCE trial, are expected to provide robust evidence to clarify oncologic outcomes of MIS. Additionally, early studies indicate MIS might be feasible for selected cases of recurrent ovarian cancer.

MIS is emerging as a viable and potentially advantageous alternative to open surgery for advanced ovarian cancer after neoadjuvant chemotherapy, provided careful patient selection and surgical expertise. Definitive conclusions about long-term oncologic outcomes and recurrence require results from randomized clinical trials.