FeasibiLity of laparoscopic debulking with electrosurgical loop excision procedure and argon beam coagulator at recurrence in patients with previous laparotomy debulking

Objectives: Our purpose is to assess the feasibility and success of laparoscopic ovarian debulking with electrosurgical loop excision procedure (LEEP) and argon beam coagulator (ABC). Methods: Thirty-six consecutive asymptomatic patients with chemosensitive stage III or IV ovarian cancer who had undergone prior laparotomy debulking and chemotherapy, underwent laparoscopic debulking at the time of elevated CA 125. Preoperative abdominal/pelvic computed tomography was negative. Operative laparoscopy was performed through an open technique in the left upper quadrant. Tumors were debulked laparoscopically by using the LEEP and the ABC. Results: Of 36 patients, 34 (94%) underwent successful laparoscopic debulking without requiring laparotomy. Of 34 patients, 32 (94%) had all visible disease resected at laparoscopy; 6% had surgical complications. Median time for surgery was 2.6 hours, median blood loss 70 mL, and median hospital stay 1 day. Seventy-four percent had a complete response after laparoscopic debulking and chemotherapy with a median progression free survival of 1.1 years. Conclusion: We present the first report of laparoscopic ovarian debulking using LEEP and ABC after elevation of CA 125 in chemosensitive, asymptomatic patients who had undergone prior laparotomy debulking. Laparoscopic debulking appears feasible (94%), successful (94%), and safe (6% complications). Prospective randomized trials are needed to determine the optimal management of asymptomatic, chemosensitive patients with elevated CA 125. (C) 2004 Elsevier Inc. All rights reserved.