ROLE OF MIS IN EARLY STAGE OVARIAN CANCER Assoc.Prof. PERAPONG INTHASORN Dept of Obstetrrics and Gynaecology SIRIRAJ HOSPITAL

LAPAROSCOPIC STAGING IN EARLY STAGE Nezhat et al (Am J Obstet Gynecol 2009) 36 patients Paraaortic node 12, pelvic node 14 Upstage 7 patients Complication 1 small bowel obstruction 3 lymphocoel

LAPAROSCOPIC STAGING IN EARLY STAGE 3 patient recurrence of disease Mean FU 55 Mo, all alive without disease

LAPAROSCOPIC STAGING IN EARLY STAGE Park HY. ( AJOG 2013) Review 3 retrospective stydy Laparoscopy less blood loss Conversion rate 3% Mean FU time > 19 Mo , recurrent rate 9.9%

LAPAROSCOPIC STAGING IN EARLY STAGE Cochran 1990-2106 No high quality RCT

LAPAROSCOPIC STAGING IN EARLY STAGE Tumor rupyure is great concern Laparoscopic bag

Second look laproscopy Clinical trial Evaluation after complete response

Second look laproscopy Laparoscopy less blood loss, less operative time (Abu Rustum 1996)

SIRIRAJ EXPERIENCE Second look laparoscopy 17 caese Laparoscopy with peritoneal washing with biopsy Positive cancer 56% No serious complication

SIRIRAJ EXPERIENCE Restaging 7 patients Blood loss 30- 100 cc Pelvic node 10-15 nodes Paraaortic 3-5 nodes No serious complication