Laparoscopic Assessment of Resectability in Ovarian Cancer: A 10-Step Standardized Approach

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Exploratory laparoscopy is crucial for assessing resectability in advanced ovarian cancer.
• Accreditation of expert centers highlights the role of peripheral hospitals in diagnosis and staging.
• A standardized approach can improve diagnostic quality and avoid treatment delays.

Purpose of the Study:

• To present a simple, reproducible 10-step laparoscopic protocol for advanced ovarian cancer staging.
• To facilitate the adoption of standardized staging practices in both expert and partner centers.
• To improve diagnostic accuracy and treatment planning for ovarian cancer patients.

Main Methods:

• A standardized 10-step laparoscopic protocol using a strict midline approach.
• Documentation of all 12 regions of the Peritoneal Cancer Index (PCI) with photography.
• Assessment of resectability using Sugarbaker's PCI, Fagotti score, and Makar classification.

Main Results:

• The protocol includes specific steps for trocar placement, cytology, abdominal/pelvic exploration, and biopsies.
• Prioritizes early peritoneal cytology and wide biopsies (10-mm) using cold scissors, with epiploic biopsy for analysis.
• Avoids biopsies near hollow organs to minimize complications.

Conclusions:

• The 10-step protocol is reproducible and anatomically ordered, suitable for adoption by expert and partner centers.
• Strengthens the role of partner centers in advanced ovarian cancer care, improving diagnostic quality and harmonizing staging.
• Promotes timely, expert-level treatment planning and may reduce care disparities.