The following is a summary of “Laparoscopic predictability of minimally invasive interval debulking in advanced ovarian cancer: The MIID-SOC trial,” published in the February 2024 issue of Obstetrics and Gynecology by Costales et al.

In the quest to refine surgical approaches for advanced epithelial ovarian cancer patients receiving neoadjuvant chemotherapy (NACT), researchers endeavored to develop a laparoscopic-based model to predict the feasibility of minimally invasive (MIS) cytoreductive surgery. This prospective pilot study, conducted across multiple institutions and registered under NCT03378128, enrolled fifty women who underwent laparoscopic evaluation of 43 abdominopelvic sites. Following this assessment, surgeons determined the surgical approach—either continuing with MIS or opting for laparotomy. 

Notably, in cases where the MIS approach was pursued, placing a hand-assist port was mandated to facilitate manual palpation, mirroring laparotomic exploration, with subsequent re-evaluation of all 43 sites. To evaluate the predictive capability of each site for MIS, resectability, sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were calculated. These parameters were assigned numeric values based on their statistical associations, culminating in assigning each patient a total predictive index score (PIV). Receiver operating characteristic (ROC) curve analysis assessed the model’s predictive ability for the MIS approach.

Of the enrolled patients, 61% (27 patients) ultimately underwent MIS surgery. The selection of abdominopelvic sites for inclusion in the predictive model encompassed critical areas such as the gastrosplenic ligament, rectum, mesocolon (left), transverse colon, right colon, cecum, appendix, liver capsule, intrahepatic fossa/gallbladder, and ileum/jejunum. Utilizing the PIV, the study group generated a ROC curve with an area under the curve (AUC) of 0.695. Notably, in the final model, a PIV <2 emerged as a threshold to identify patients suitable for optimal MIS cytoreductive surgery, boasting an accuracy of 68.2%. Additionally, the model exhibited a specificity of 66.7% in identifying patients not amenable to optimal MIS interval cytoreductive surgery.

In conclusion, their predictive index model offers valuable insights that may inform future inclusion criteria for randomized studies assessing the efficacy of the MIS approach in advanced epithelial ovarian cancer. By refining patient selection criteria, the investigators aim to enhance the precision and success of MIS cytoreductive surgery, ultimately optimizing patient outcomes in this challenging clinical setting.

Source: sciencedirect.com/science/article/abs/pii/S0090825824001161