Minimally Invasive Surgery in Ovarian Cancer

Dear Colleagues,

Ovarian cancer represents one of the most lethal cancers in women.  Data from the SEER database report a 5-year relative survival of 49.7%. Unfortunately, about 80% of cases are diagnosed in an advanced FIGO stage due to the lack of a screening protocol for this kind of disease and non-specific symptoms at diagnosis. There are five most common histological types of ovarian cancer (high-grade, low-grade, mucinous, endometrioid, and clear-cell), and they represent inherently different diseases, as indicated by differences in risk factors, molecular genetic abnormalities, natural history, and response to chemotherapy. Not only the histotype, but also the homologous recombination deficiency (HRD), status of BRCA genes, and pathological factors have been shown to have an impact on the history of the disease; the addition of bevacizumab and PARP inhibitors has affected the treatment of ovarian cancer.

The aim of surgical treatment consists of complete cytoreduction in advanced stages and surgical staging in early stages, which can include, according to the histological type, bilateral salpingo-oophorectomy, hysterectomy, omentectomy, pelvic and aortic lymphadenectomy, peritoneal biopsies, and washing. Although guidelines still suggest laparotomy as the standard approach, in recent years minimally invasive surgery (MIS) has become more and more popular in the treatment of ovarian cancer, especially in the early stages, in which the 5-year relative survival exceeds 90% and patients’ quality of life cannot be overshadowed. MIS has been demonstrated to have a role even in advanced stages, in the prediction of optimal cytoreduction, identifying patients who may benefit from primary debulking surgery or neoadjuvant chemotherapy, identifying high-risk patients, starting neoadjuvant chemotherapy as soon as possible, and, more recently, in interval debulking surgery. Furthermore, the minimally invasive approach is extremely important in prophylactic surgeries in women with familial syndromes or germline mutations in BRCA genes and in fertility-sparing treatment, in which future attempts at pregnancy may be influenced by too-invasive surgery.

The aim of this Special Issue is to describe the minimally invasive approach, with its advantages and pitfalls, in the treatment of ovarian cancer, from early stage disease to advanced stages and recurrences. 

Dr. Luigi Pedone Anchora
Dr. Valerio Gallotta
Guest Editors

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• minimally invasive surgery in early ovarian cancer 
• robotic surgery 
• secondary cytoreduction and minimally invasive surgery
• HIPEC and minimally invasive surgery
• interval debulking surgery and laparoscopy