H. Endres

Impact of diagnostic laparoscopy on resectability and treatment strategy in FIGO III–IV ovarian cancer

Abstract Objective To investigate the clinical utility of diagnostic laparoscopy in guiding treatment strategy and surgical outcomes for patients with advanced-stage ovarian cancer, specifically regarding operability assessment and the likelihood of complete cytoreduction. Methods This retrospective cohort study analyzed 183 patients with histologically confirmed International Federation of Gynecology and Obstetrics (FIGO) stage III–IV ovarian cancer treated with curative intent between January 2018 and December 2023 at a tertiary referral center. Patients were divided into two groups: those who underwent diagnostic laparoscopy prior to primary treatment ( n  = 80) and those managed without laparoscopy ( n  = 103). Laparoscopy was selectively employed when operability was uncertain. The primary outcome was the rate of complete macroscopic tumor resection. Secondary endpoints included intraoperative inoperability, neoadjuvant chemotherapy (NACT) rates, and surgical complexity. Statistical analyses included chi-square tests and predictive value calculations. Results Complete macroscopic resection was achieved in 57.5% of patients in the laparoscopy group compared to 68.0% in the control group. Among FIGO III cases, complete resection was lower in the laparoscopy group (63.0% vs. 77.0%), while rates were similar for FIGO IV (53.8% vs. 54.8%). Diagnostic laparoscopy had a positive predictive value of 59% and was a statistically significant, albeit weak, predictor of operability ( p  = 0.003, phi = 0.13). Patients in the laparoscopy group were more frequently triaged to NACT (78.8% vs. 50.5%). Intraoperative inoperability was also higher (29% vs. 14%). Conclusion Diagnostic laparoscopy influenced treatment strategy by increasing NACT use and reducing non-beneficial surgeries. Though it did not improve overall cytoreduction rates, it enabled personalized treatment planning, especially in patients with ambiguous resectability, thereby potentially lowering surgical morbidity.

Preoperative colonoscopy in ovarian cancer: impact on surgical planning and outcomes: results from a retrospective, single-center study

Abstract Background Diagnosis and management of ovarian cancer remain complex due to the overlap of symptoms with other malignancies and the variability in preoperative diagnostic approaches. While histological confirmation is crucial, the role of preoperative colonoscopy in improving surgical planning and patient outcomes remains unclear. Objective This study aims to evaluate the impact of preoperative colonoscopy on surgical outcomes, peri-operative complications and interdisciplinary coordination in ovarian cancer patients. Methods A retrospective, single-center study was conducted at the University Medical Center Freiburg, including 306 patients diagnosed with malignant ovarian tumors between 2016 and 2023. Patients were stratified into two groups: those who underwent preoperative colonoscopy (n=104) and those who did not (n=202). Tumor characteristics, diagnostic findings, and surgical outcomes were compared. Primary endpoints included the detection of abnormal colonoscopic findings and their correlation with intraoperative interventions. Secondary endpoints assessed the impact of colonoscopy on macroscopic complete resection rates and peri-operative complications. Results Patients undergoing preoperative colonoscopy exhibited higher rates of advanced tumor stages (FIGO III/IV: 84.5% vs. 47.5%). Abnormal colonoscopic findings were observed in 38.8% of cases, yet colorectal resections were performed in only 53% of these patients. Despite a higher frequency of neoadjuvant chemotherapy in the colonoscopy group (57.3 vs. 33.7%), macroscopic complete resection rates were lower (67.0 vs. 79.2%). Sensitivity and specificity analyses indicated moderate predictive accuracy of colonoscopy for colorectal involvement (67 and 74%, respectively). In advanced ovarian cancer, preoperative colonoscopy influenced colorectal surgery decisions, with higher resection rates but minimal impact on neoadjuvant chemotherapy rates, despite moderate sensitivity and specificity. Conclusion While preoperative colonoscopy identified colorectal involvement in a subset of ovarian cancer patients, particularly in advanced tumor stages, its impact on surgical decision-making, oncological outcomes, and physicians' choice for neoadjuvant chemotherapy was limited. The findings suggest that intraoperative assessments remain the primary determinant for colorectal interventions. Future prospective studies are warranted to clarify the clinical utility of colonoscopy in preoperative evaluation and its potential influence on interdisciplinary surgical strategies. Retrospectively registered study 24-1364-S1-retro