Laparoscopic Ovarian Metastasectomy During Intraperitoneal Administration of Paclitaxel Chemotherapy for Gastric Cancer: A Report of Six Cases.

Intraperitoneal (IP) paclitaxel therapy with intravenous paclitaxel plus S-1 is a novel treatment for advanced gastric cancer with peritoneal dissemination; however, its effectiveness against ovarian metastases remains limited. In such cases, ovarian metastasectomy may be considered as an alternative to chemotherapy, but its safety and efficacy are unclear. We reported the six cases of laparoscopic ovarian metastasectomy for gastric cancer during IP and intravenous paclitaxel plus S-1 therapy. The median patient age was 40.5 years, and ovarian metastases were metachronous in five cases. All six surgeries were completed successfully without complications, adhesions, or conversion to open surgery. The median interval between ovarian metastasectomy and resumption of IP paclitaxel chemotherapy was 11.5 days. Three patients had a large amount of ascites before surgery, but the ascites decreased after the procedure. Four patients died from cancer, with a median postoperative survival of 18.5 months, excluding two patients who remained alive. Laparoscopic ovarian metastasectomy was feasible when peritoneal dissemination was well controlled by IP paclitaxel, and there were no strong adhesions around the ovarian metastases, which were presumed to have spread via lymphatic or hematogenous routes. Furthermore, ovarian metastasectomy reduced postoperative ascites formation, and the minimally invasive approach enabled the early resumption of IP paclitaxel therapy after a short treatment suspension. As a limitation, it was difficult to evaluate improvement in oncologic outcomes because of strong selection bias. In conclusion, laparoscopic ovarian metastasectomy is a safe and viable option for selective patients; however, further research is needed to confirm its long-term benefits.