The role of video-assisted thoracoscopic surgery in patients with advanced ovarian malignancies

  • Ahmed Ali Eleba Alexandria University
Keywords: Video-assisted; Ovarian cancer; Stage III, IV; VATS; CT staging; Malignancy.


Background: Through  video-assisted thoracoscopic surgery (VATS), physicians can perform pleural effusion drainage in addition to evaluating macroscopic pleural disease and, in certain cases, removing large tumors. When compared to the chest CT , VATS can change the therapeutic plan of ovarian cancer patients and enhance FIGO staging accuracy. The key aim of this study is to inspect the accuracy of preoperative chest CT scans and the relevance of VATS in the decision-making process for patients with advanced ovarian cancer.

Methods: This prospective study was conducted during the period between June 2021 and January 2023.  Patients with advanced ovarian cancer  (Stage III OR IV) were enrolled in the study and believed qualified to obtain the VATS. Preoperative evaluation of supra-diaphragmatic disease by Chest-CT was equated with the intra-operative VATS estimation to consider the function of VATS in further treatment choices in those patients.

Results: There was a statistically meaningful variation between chest CT and VATS in detection rate of pleural nodules in advanced stage ovarian cancer patients. 8.8 % (6) of cases displayed suspicious nodules by chest CT, whereas pleural nodules were found in 29.4% (20) of cases during VATS. It changed disease stage in 32.4% (22) of patients. Overall, VATS changed preliminary management decision based on clinical and radiological preoperative assessment in 18 patients constituting 26.5% of cases enrolled in our study.

Conclusion: When ovarian cancer is assumed to be advanced, VATS can be used to define the amount of the disease, obtain tissue for histopathologic diagnosis if macroscopic disease is found, treat the effusion, and choose patients for intrathoracic cytoreduction or neoadjuvant chemotherapy quickly and safely. Furthermore, VATS is more effective than chest CT in detecting intrathoracic disease.