What are The Optimal Surgical Staging Procedures for Fallopian Tube Cancer in Terms of Diagnostic Accuracy, Morbidity, and Long-Term Patient Outcomes? : A Systematic Review
Keywords:
Fallopian tube cancer, surgical staging, lymphadenectomy, STIC, minimally invasive surgery, cytoreduction, upstagingAbstract
Introduction: Primary fallopian tube cancer (PFTC) is a rare gynecologic malignancy that shares clinical and histological features with epithelial ovarian cancer. The optimal surgical staging procedures for PFTC and its precursor, serous tubal intraepithelial carcinoma (STIC), remain incompletely defined due to limited prospective data.
Methods: This systematic review synthesized evidence from 16 studies, including RCT, etc. Data were extracted on diagnostic accuracy (upstaging rates), surgical morbidity, long-term outcomes (survival, recurrence), and comparative effectiveness of staging approaches (laparoscopy vs. laparotomy, complete vs. incomplete staging, extraperitoneal vs. transperitoneal lymphadenectomy).
Results: For PFTC, comprehensive surgical staging (hysterectomy, bilateral salpingo-oophorectomy, omentectomy, lymphadenectomy, peritoneal cytology/biopsies) improved 5-year survival from 33.3% to 65.4% (p=0.043) (Yu et al., 2007). Optimal cytoreduction significantly improved survival (68.4% vs. 41.7%, p=0.044) (Yu et al., 2007). Upstaging rates for apparent early-stage adnexal cancers were 23% (Brockbank et al., 2013). For STIC, upstaging varied from 0% in BRCA carriers undergoing risk-reducing surgery (Hoeven et al., 2018) to 43% in incidental STIC in low-risk women (Chay et al., 2015). Minimally invasive staging reduced blood loss, hospital stay, and lymphatic ascites (p<0.05) compared to laparotomy (Nezhat et al., 2010; Pérez-Medina et al., 2015; Kerbage et al., 2020). Extraperitoneal para-aortic lymphadenectomy had fewer intraoperative complications (OR 0.40, p=0.001) but more lymphoceles (OR 4.12) than transperitoneal approach (Li et al., 2021).
Discussion: The evidence supports complete surgical staging and optimal cytoreduction for PFTC. For STIC, staging is most clearly indicated when incidentally found in non-BRCA patients. Minimally invasive approaches are preferred due to lower morbidity, provided tumor rupture is avoided. The independent prognostic value of lymphadenectomy remains debated, while omentectomy shows consistent survival benefit.
Conclusion: Optimal surgical staging for fallopian tube cancer should include systematic lymphadenectomy, omentectomy, peritoneal biopsies, and cytology, aiming for no residual disease. Laparoscopic staging is safe and effective for early-stage and selected advanced cases. STIC management should be individualized based on BRCA status and clinical context.
References
Tounsi N, Bouazize H, Margheli I, et al (2021) Primary Fallopian Tube Carcinoma: Results of a Single-Institutional Retrospective Analysis of 17 Patients with Evaluation of Staging and Prognostic Factors. Gynecology obstetrics & reproductive medicine. https://doi.org/10.21613/GORM.2021.1075
Cozlea A, Gheorghe M, Kiss S, et al (2021) Malignant mixed Müllerian tumor of the fallopian tube: Case report and literature review. Experimental and Therapeutic Medicine. https://doi.org/10.3892/etm.2021.11100
Yu A, Fang S, Gao Y (2007) [Analysis of therapeutic result and prognostic factor in primary fallopian tube carcinoma]. Zhonghua zhong liu za zhi [Chinese journal of oncology]
Ruel-Laliberté J, Kasasni SM, Oprea D, Viau M (2022) Outcome and management of STIC following opportunistic salpingectomy: systematic review and meta-analysis. Journal of Obstetrics and Gynaecology Canada. https://doi.org/10.1016/j.jogc.2022.08.018
Chay W, McCluggage W, Lee C, et al (2015) Outcomes of Incidental Fallopian Tube High-Grade Serous Carcinoma and Serous Tubal Intraepithelial Carcinoma in Women at Low Risk of Hereditary Breast and Ovarian Cancer. International Journal of Gynecologic Cancer. https://doi.org/10.1097/IGC.0000000000000639
Brockbank E, Harry V, Kolomainen D, et al (2013) Laparoscopic staging for apparent early stage ovarian or fallopian tube cancer. First case series from a UK cancer centre and systematic literature review. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2013.05.007
Hoeven NVD, Wijk KV, Bonfrer SE, et al (2018) Outcome and Prognostic Impact of Surgical Staging in Serous Tubal Intraepithelial Carcinoma: A Cohort Study and Systematic Review. Clinics in oncology. https://doi.org/10.1016/j.clon.2018.03.036
Covens A, Dodge J, Lacchetti C, et al (2012) Surgical management of a suspicious adnexal mass: a systematic review. Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2012.04.018
Nezhat F, Denoble SM, Liu CS, et al (2010) The Safety and Efficacy of Laparoscopic Surgical Staging and Debulking of Apparent Advanced Stage Ovarian, Fallopian Tube and Primary Peritoneal Cancers. Journal of Minimally Invasive Gynecology. https://doi.org/10.1016/j.jmig.2010.08.225
Pérez-Medina T, Pereira A, San-Frutos L, et al (2015) Lymphatic ascites after retroperitoneal lymphadenectomy in gynecologic cancer. Surgical oncology. https://doi.org/10.1016/j.suronc.2015.06.003
Li K, Deng X, Wu T (2021) Surgical Outcomes of Transperitoneal Para-Aortic Lymphadenectomy Compared With Extraperitoneal Approach in Gynecologic Cancers: A Systematic Review and Meta-Analysis. Frontiers in Surgery. https://doi.org/10.3389/fsurg.2021.779372
Onda T, Kobayashi H, Nakanishi T, et al (2009) Feasibility study of neoadjuvant chemotherapy followed by interval debulking surgery for stage III/IV ovarian, tubal, and peritoneal cancers: Japan Clinical Oncology Group Study JCOG0206. Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2008.12.027
Escobar P, Fader A, Rasool N, Espalliat LR (2010) Single-Port Laparoscopic Pelvic and Para-Aortic Lymph Node Sampling or Lymphadenectomy: Development of a Technique and Instrumentation. International Journal of Gynecologic Cancer. https://doi.org/10.1111/IGC.0b013e3181ea7f5d
Sam A, George J, Mathew B (2019) Less Common Gynecologic Malignancies: An Integrative Review. Seminars in Oncology Nursing. https://doi.org/10.1016/j.soncn.2019.02.004
Kerbage Y, Kakkos A, Kridelka F, et al (2020) Lomboaortic Lymphadenectomy in Gynecological Oncology: Laparotomy, Laparoscopy or Robot-Assisted Laparoscopy? Annals of Surgical Oncology. https://doi.org/10.1245/s10434-020-08471-0
Lowery W, Leath C, Robinson R (2012) Robotic surgery applications in the management of gynecologic malignancies. Journal of Surgical Oncology. https://doi.org/10.1002/jso.22080
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