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Joyce F. Liu, MD, MPH
Joyce F. Liu, MD, MPH
Posted: Tuesday, January 21, 2025
Results of the lead-in pilot phase of LANCE—an international, open-label, noninferiority randomized controlled trial—indicate that it will be feasible to conduct the trial on its full planned scale in patients with epithelial ovarian cancer. The trial will compare the oncologic efficacy of minimally invasive surgery (laparoscopic or robotic surgery) with that of laparotomy, wrote J. Alejandro Rauh-Hain, MD, MPH, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues in JAMA Surgery.
Minimally invasive surgery is increasingly used to treat advanced epithelial ovarian cancer, “despite the absence of high-quality evidence of its safety and effectiveness,” the team declared. This pilot phase showed the team could meet the predefined patient accrual rate (5.6 patients per month), maintain 25% or lower frequency of treatment crossover (from minimally invasive surgery to laparotomy), and accomplish a comparable proportion of complete gross resection in patients in both arms.
The 100 LANCE patients in this phase, treated at 11 academic cancer centers and randomly assigned 1:1 over a 29-month period to receive minimally invasive surgery or laparotomy, were all candidates for interval cytoreductive surgery. The women (median age, 63 years) had advanced-stage (stage IIIC, 67%), high-grade epithelial ovarian cancer (or epithelial fallopian or primary peritoneal carcinoma), normal CA-125 levels, and at least a partial response to neoadjuvant chemotherapy.
Conversion from minimally invasive surgery to laparotomy was performed in 6 of 48 evaluable patients. Further, surgeons successfully completed resection in 39 of 47 patients assigned to laparotomy.
The pilot study also presented evidence that fewer postoperative complications may occur with minimally invasive surgery vs laparotomy. Additionally, “the median duration of postoperative hospitalization was 3 days shorter after minimally invasive surgery vs after laparotomy, [and] social function, as measured with the EORTC QLQ-C30 at the first postoperative visit, was better among the patients assigned to minimally invasive surgery compared with those assigned to laparotomy.”
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
