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Published on: January 22, 2022
Impact of Diagnostic Laparoscopy on Iatrogenic Injury Risk During Interval Debulking Surgery in Advanced Epithelial
Haoyue Liu1, Zhaoning Duan1, Wenman Li1
1Department of Obstetrics and Gynecology, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing, China.
Objective:
This study aimed to evaluate the impact of diagnostic laparoscopy (DL) on surgical outcomes during interval debulking surgery (IDS) in patients with advanced epithelial ovarian cancer (AEOC).
Design:
Retrospective cohort study with propensity score matching (PSM).
Setting:
The First Affiliated Hospital of Chongqing Medical University.
Patients:
Patients with FIGO stage III-IV AEOC treated with neoadjuvant chemotherapy (NACT) followed by IDS between March 2014 and March 2024 were enrolled.
Interventions:
Participants were categorized into two groups: those who underwent diagnostic laparoscopy (DL) and those who did not (Non-DL).
Measurements And Main Results:
A total of 240 patients were enrolled. Following 1:1 PSM (n = 75 per group), the DL group exhibited a significantly longer median operative time (296 min vs 200 min, p <.001), higher intraoperative blood loss (200 mL vs 150 mL, p <.001), and a higher iatrogenic injury rate (20.00% vs 4.00%, p = .003) compared to the Non-DL group. In the adjusted model, diagnostic laparoscopy was identified as a significant independent predictor of iatrogenic injury (OR = 8.997, 95% CI, 1.917-42.219). Progression-free survival (PFS, p = .215) and overall survival (OS, p = .109) were comparable between the two groups.
Conclusion:
Diagnostic laparoscopy prior to neoadjuvant chemotherapy for advanced ovarian cancer is associated with an increased risk of iatrogenic injury during subsequent IDS. While these technical challenges do not compromise oncological outcomes, it is essential to implement enhanced preoperative assessments and meticulous intraoperative management to mitigate the risk of adverse events during IDS.
