{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T04:09:50Z","timestamp":1792814990785,"version":"4.5.0"},"reference-count":77,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: The objective in epithelial ovarian cancer is to reach maximal cytoreduction with no visible residual tumor. Tumor detection during cytoreductive surgery depends on visual inspection, palpation, or blind biopsy, methods that lack reliability for identifying microscopic disease. Although the importance of microscopic disease in epithelial ovarian cancer is controversial, it may harbor chemoresistant cells and explain the high recurrence rates. Fluorescence-guided surgery (FGS) is an emerging approach. However, the potential in ovarian cancer remains underexplored; the majority of the existing evidence pertains to gastrointestinal tumors and a limited group of ovarian cancer patients. Their comparative effectiveness is still uncertain. Objective: To systematically review and evaluate the role of fluorescence-guided surgical techniques in detecting microscopic disease in ovarian cancer and compare their efficacy to total peritonectomy. Data Sources: A systematic search was made in three databases (PubMed, Web of Science, and Embase). The search was conducted from 1975 to 2024, including randomized controlled trials, observational studies, and conference abstracts in the last 25 years. Study Selection: Clinical studies published in English involving ovarian cancer patients undergoing FGS or total peritonectomy were included. Case reports, reviews, animal studies, and studies involving mixed cancer populations without ovarian cancer-specific data were excluded. Two independent reviewers screened 631 studies, yielding 12 eligible studies for final analysis. Data Extraction and Synthesis: Data were extracted and synthesized in accordance with PRISMA and MOOSE guidelines, using random-effects models for independent analysis. Sensitivity, specificity, positive predictive value (PPV), and odds ratios (ORs) were grouped, accompanied by subgroup analyses based on the fluorescence agent employed. For quality assessment, we utilized the NIH quality tool. Main Outcome(s) and Measure(s): The primary outcome was the rate of change in surgical management due to fluorescence guidance or total peritonectomy. Secondary outcomes comprised lesion-level sensitivity, specificity, and PPV. Safety outcomes included adverse events associated with fluorescence agents. Results: There were 12 studies involving 429 ovarian cancer patients. FGS improved the detection of microscopic disease compared to standard visualization methods, with a pooled sensitivity of 0.77. Folate receptor-targeted agents had high sensitivity (84%) but low specificity (26%). Aminolevulinic acid (5-ALA) showed superior diagnostic accuracy with a sensitivity of 84% and a specificity of 96%. Total peritonectomy showed no significant advantage over FGS for detecting microscopic disease. The adverse events were mild, with no serious events reported. We observed a high heterogeneity across studies and methodologies. Conclusions and Relevance: Fluorescence-guided surgery utilizing fluorescence tracers demonstrates potential in improving the detection of microscopic disease and may change surgical management in epithelial ovarian cancer, particularly with 5-ALA. Variability in performance and limited data on survival outcomes necessitates additional research. Total peritonectomy does not offer further advantage in the detection of microscopic disease. Future trials should focus on standardizing methodology and evaluating the effects of microscopic disease removal on survival outcomes. Registration: The study was registered to PROSPERO as CRD42024578274.<\/jats:p>","DOI":"10.3390\/cancers17030410","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T07:46:29Z","timestamp":1737963989000},"page":"410","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Fluorescence-Guided Surgery to Detect Microscopic Disease in Ovarian Cancer: A Systematic Review with Meta-Analysis"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5993-6968","authenticated-orcid":false,"given":"Evrim","family":"Erdemoglu","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, AZ 85054, USA"},{"name":"Department of Gynecologic Oncology, Suleyman Demirel University, Isparta 32260, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9361-8392","authenticated-orcid":false,"given":"Carrie L.","family":"Langstraat","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1470-1305","authenticated-orcid":false,"given":"Amanika","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3524-8626","authenticated-orcid":false,"given":"Stuart A.","family":"Ostby","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlene E.","family":"Girardo","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0512-4435","authenticated-orcid":false,"given":"Andrea","family":"Giannini","sequence":"additional","affiliation":[{"name":"Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina A.","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S88","DOI":"10.1016\/S0959-8049(11)70152-6","article-title":"Primary surgery or neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer","volume":"47","author":"Vergote","year":"2011","journal-title":"Eur. J. Cancer"},{"key":"ref_2","first-page":"101","article-title":"Surgical resection of tumor bulk in the primary treatment of ovarian carcinoma","volume":"42","author":"Griffiths","year":"1975","journal-title":"Natl. Cancer Inst. Monogr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1002\/cncr.24149","article-title":"Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials: By the Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom (AGO-OVAR) and the Groupe d\u2019Investigateurs Nationaux Pour les Etudes des Cancers de l\u2019Ovaire (GINECO)","volume":"115","author":"Reuss","year":"2009","journal-title":"Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ygyno.2019.08.016","article-title":"State of the science: Evolving role of surgery for the treatment of ovarian cancer","volume":"155","author":"Gardner","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ygyno.2010.05.031","article-title":"The incidence of major complications after the performance of extensive upper abdominal surgical procedures during primary cytoreduction of advanced ovarian, tubal, and peritoneal carcinomas","volume":"119","author":"Chi","year":"2010","journal-title":"Gynecol. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ygyno.2018.08.014","article-title":"Continuous improvement in primary Debulking surgery for advanced ovarian cancer: Do increased complete gross resection rates independently lead to increased progression-free and overall survival?","volume":"151","author":"Tseng","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1097\/IGC.0000000000000007","article-title":"Ovarian cancer: Sites of recurrence","volume":"23","author":"Amate","year":"2013","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.annonc.2023.11.015","article-title":"ESGO-ESMO-ESP consensus conference recommendations on ovarian cancer: Pathology and molecular biology and early, advanced and recurrent disease","volume":"35","author":"Ledermann","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_9","first-page":"213","article-title":"Analysis of failures and clinical outcome of advanced epithelial ovarian cancer in patients with microscopic residual disease at second-look reassessment following primary cytoreductive surgery and first-line platinum-based chemotherapy","volume":"34","author":"Gadducci","year":"2013","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1136\/ijgc-2023-004995","article-title":"Updated progression-free survival and final overall survival with maintenance olaparib plus bevacizumab according to clinical risk in patients with newly diagnosed advanced ovarian cancer in the phase III PAOLA-1\/ENGOT-ov25 trial","volume":"34","author":"Lorusso","year":"2024","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"512","DOI":"10.6004\/jnccn.2024.0052","article-title":"NCCN Guidelines\u00ae Insights: Ovarian Cancer\/Fallopian Tube Cancer\/Primary Peritoneal Cancer, Version 3.2024","volume":"22","author":"Liu","year":"2024","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s13048-024-01362-y","article-title":"PARP inhibitor era in ovarian cancer treatment: A systematic review and meta-analysis of randomized controlled trials","volume":"17","author":"Teutsch","year":"2024","journal-title":"J. Ovarian Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2391","DOI":"10.1056\/NEJMoa1910962","article-title":"Niraparib in Patients with Newly Diagnosed Advanced Ovarian Cancer","volume":"381","author":"Pothuri","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2495","DOI":"10.1056\/NEJMoa1810858","article-title":"Maintenance Olaparib in Patients with Newly Diagnosed Advanced Ovarian Cancer","volume":"379","author":"Moore","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2416","DOI":"10.1056\/NEJMoa1911361","article-title":"Olaparib plus Bevacizumab as First-Line Maintenance in Ovarian Cancer","volume":"381","author":"Pautier","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.annonc.2024.08.2241","article-title":"Niraparib first-line maintenance therapy in patients with newly diagnosed advanced ovarian cancer: Final overall survival results from the PRIMA\/ENGOT-OV26\/GOG-3012 trial","volume":"35","author":"Monk","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"107957","DOI":"10.1016\/j.ejso.2024.107957","article-title":"Peritonectomy and resection of mesentery during Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer: A phase I-II trial","volume":"50","author":"Tozzi","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.3802\/jgo.2024.35.e14","article-title":"Feasibility of laparoscopic Visceral-Peritoneal Debulking (L-VPD) in patients with stage III-IV ovarian cancer: The ULTRA-LAP trial pilot study","volume":"35","author":"Tozzi","year":"2024","journal-title":"J. Gynecol. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"336","DOI":"10.3802\/jgo.2015.26.4.336","article-title":"Role of aggressive surgical cytoreduction in advanced ovarian cancer","volume":"26","author":"Chang","year":"2015","journal-title":"J. Gynecol. Oncol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"81.e1","DOI":"10.1016\/j.ajog.2006.08.043","article-title":"Occult metastasis in early ovarian cancers: Risk factors and associated prognosis","volume":"196","author":"Ayhan","year":"2007","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Belia, F., Biondi, A., Agnes, A., Santocchi, P., Laurino, A., Lorenzon, L., Pezzuto, R., Tirelli, F., Ferri, L., and D\u2019Ugo, D. (2022). The Use of Indocyanine Green (ICG) and Near-Infrared (NIR) Fluorescence-Guided Imaging in Gastric Cancer Surgery: A Narrative Review. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.880773"},{"key":"ref_22","first-page":"3641","article-title":"Indocyanine green fluorescence applied to gynecologic oncology: Beyond sentinel lymph node","volume":"110","author":"Loverro","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1002\/jso.25149","article-title":"Intraoperative fluorescence imaging in thoracic surgery","volume":"118","author":"Newton","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"32144","DOI":"10.18632\/oncotarget.8282","article-title":"Intraoperative imaging of folate receptor alpha positive ovarian and breast cancer using the tumor specific agent EC17","volume":"7","author":"Tummers","year":"2016","journal-title":"Oncotarget"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ricciardi, L., Sturiale, C.L., Scerrati, A., Stifano, V., Somma, T., Ius, T., Trungu, S., Acqui, M., Raco, A., and Miscusi, M. (2022). 5-Aminolevulinic Acid False-Positive Rates in Newly Diagnosed and Recurrent Glioblastoma: Do Pseudoprogression and Radionecrosis Play a Role? A Meta-Analysis. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.848036"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Harada, Y., Murayama, Y., Takamatsu, T., Otsuji, E., and Tanaka, H. (2022). 5-Aminolevulinic Acid-Induced Protoporphyrin IX Fluorescence Imaging for Tumor Detection: Recent Advances and Challenges. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23126478"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1007\/s11307-023-01853-2","article-title":"A pH-Activatable Nanoprobe Labels Diverse Histologic Subtypes of Human Lung Cancer During Resection","volume":"25","author":"Kennedy","year":"2023","journal-title":"Mol. Imaging Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s41571-021-00548-3","article-title":"Fundamentals and developments in fluorescence-guided cancer surgery","volume":"19","author":"Mieog","year":"2022","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2378","DOI":"10.1097\/JS9.0000000000000459","article-title":"Approved and investigational fluorescent optical imaging agents for disease detection in surgery","volume":"109","author":"Rehman","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1038\/s41571-023-00819-1","article-title":"Heterogeneity and treatment landscape of ovarian carcinoma","volume":"20","author":"Veneziani","year":"2023","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1001\/jamasurg.2021.0522","article-title":"MOOSE Reporting Guidelines for Meta-analyses of Observational Studies","volume":"156","author":"Brooke","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.suronc.2017.01.001","article-title":"Dealing with microscopic peritoneal metastases of epithelial ovarian cancer. A surgical challenge","volume":"26","author":"Estevez","year":"2017","journal-title":"Surg. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Moinard, M., Augustin, J., Carrier, M., Da Ma\u00efa, E., Penel, A., Belghiti, J., Nikpayam, M., Gonthier, C., Canlorbe, G., and Acherar, S. (2022). Residual Microscopic Peritoneal Metastases after Macroscopic Complete Cytoreductive Surgery for Advanced High-Grade Serous Ovarian Carcinoma: A Target for Folate Receptor Targeted Photodynamic Therapy?. Pharmaceuticals, 15.","DOI":"10.3390\/ph15081034"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"503.e1","DOI":"10.1016\/j.ajog.2015.10.922","article-title":"Minimally invasive interval debulking surgery in ovarian neoplasm (MISSION trial-NCT02324595): A feasibility study","volume":"214","author":"Bottoni","year":"2016","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"632.e1","DOI":"10.1016\/j.ajog.2014.06.034","article-title":"Prognostic role and predictors of complete pathologic response to neoadjuvant chemotherapy in primary unresectable ovarian cancer","volume":"211","author":"Petrillo","year":"2014","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1245\/s10434-022-12861-x","article-title":"Visual Peritoneal Evaluation of Residual Disease After Neoadjuvant Chemotherapy in Advanced Ovarian Cancer Patients: The VIPER Study","volume":"30","author":"Costantini","year":"2023","journal-title":"Ann. Surg. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2271","DOI":"10.7314\/APJCP.2016.17.4.2271","article-title":"5-Aminolevulinic Acid Fluorescence in Detection of Peritoneal Metastases","volume":"17","author":"Yonemura","year":"2016","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4726","DOI":"10.1245\/s10434-024-15165-4","article-title":"Detection of Residual Peritoneal Metastases Following Cytoreductive Surgery Using Pegsitacianine, a pH-Sensitive Imaging Agent: Final Results from a Phase II Study","volume":"31","author":"Wagner","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/jso.24807","article-title":"ICG-fluorescence imaging for detection of peritoneal metastases and residual tumoral scars in locally advanced ovarian cancer: A pilot study","volume":"117","author":"Veys","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.ygyno.2019.07.010","article-title":"A phase II, multicenter, open-label trial of OTL38 injection for the intra-operative imaging of folate receptor-alpha positive ovarian cancer","volume":"155","author":"Randall","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4256","DOI":"10.1245\/s10434-014-3901-5","article-title":"Cytoreductive surgery under aminolevulinic acid-mediated photodynamic diagnosis plus hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from ovarian cancer and primary peritoneal carcinoma: Results of a phase I trial","volume":"21","author":"Liu","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/lsm.22613","article-title":"Photodynamic diagnosis with 5-aminolevulinic acid for intraoperative detection of peritoneal metastases of ovarian cancer: A feasibility and dose finding study","volume":"49","author":"Hillemanns","year":"2017","journal-title":"Lasers Surg. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1002\/lsm.20302","article-title":"Fluorescence staining of human ovarian cancer tissue following application of 5-aminolevulinic acid: Fluorescence microscopy studies","volume":"38","author":"Diddens","year":"2006","journal-title":"Lasers Surg. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1002\/cncr.20155","article-title":"Laparoscopic fluorescence detection of ovarian carcinoma metastases using 5-aminolevulinic acid-induced protoporphyrin IX","volume":"100","author":"Diddens","year":"2004","journal-title":"Cancer"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2929","DOI":"10.1158\/1078-0432.CCR-15-2640","article-title":"A Novel Tumor-Specific Agent for Intraoperative Near-Infrared Fluorescence Imaging: A Translational Study in Healthy Volunteers and Patients with Ovarian Cancer","volume":"22","author":"Hoogstins","year":"2016","journal-title":"Clin. Cancer Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.ejso.2019.01.009","article-title":"Patterns of pathological response to neoadjuvant chemotherapy and its clinical implications in patients undergoing interval cytoreductive surgery for advanced serous epithelial ovarian cancer- A study by the Indian Network for Development of Peritoneal Surface Oncology (INDEPSO)","volume":"45","author":"Bhatt","year":"2019","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ejso.2020.10.012","article-title":"Distribution of residual disease in the peritoneum following neoadjuvant chemotherapy in advanced epithelial ovarian cancer and its potential therapeutic implications","volume":"47","author":"Bhatt","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1200\/JCO.22.00291","article-title":"A Phase III Study of Pafolacianine Injection (OTL38) for Intraoperative Imaging of Folate Receptor-Positive Ovarian Cancer (Study 006)","volume":"41","author":"Tanyi","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_50","first-page":"A333","article-title":"Indocyanine green in near-infrared light for intra-operative imaging of residual ovarian cancer after neoadjuvant chemotherapy: Initial experience. Int. J. Gynecol","volume":"32","author":"Kubelac","year":"2022","journal-title":"Cancer"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1038\/s41416-022-02031-x","article-title":"Folate receptor alpha in ovarian cancer tissue and patient serum is associated with disease burden and treatment outcomes","volume":"128","author":"Bax","year":"2023","journal-title":"Br. J. Cancer"},{"key":"ref_52","first-page":"227","article-title":"Treatment algorithm in patients with ovarian cancer","volume":"12","author":"Vergote","year":"2020","journal-title":"Facts Views Vis. Obgyn"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1007\/s00259-023-06141-3","article-title":"Prospective validation of tumor folate receptor expression density with the association of pafolacianine fluorescence during intraoperative molecular imaging-guided lung cancer resections","volume":"50","author":"Azari","year":"2023","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"9395","DOI":"10.1158\/0008-5472.CAN-09-2050","article-title":"Folate receptor beta is expressed by tumor-associated macrophages and constitutes a marker for M2 anti-inflammatory\/regulatory macrophages","volume":"69","author":"Samaniego","year":"2009","journal-title":"Cancer Res."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Dindere, M.E., Tanca, A., Rusu, M., Liehn, E.A., and Bucur, O. (2022). Intraoperative Tumor Detection Using Pafolacianine. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms232112842"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.ygyno.2017.10.011","article-title":"Predictive modeling for determination of microscopic residual disease at primary cytoreduction: An NRG Oncology\/Gynecologic Oncology Group 182 Study","volume":"148","author":"Horowitz","year":"2018","journal-title":"Gynecol. Oncol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.ygyno.2015.12.004","article-title":"Diaphragmatic peritonectomy vs. full thickness resection with pleurectomy during Visceral-Peritoneal Debulking (VPD) in 100 consecutive patients with stage IIIC-IV ovarian cancer: A surgical-histological analysis","volume":"140","author":"Ferrari","year":"2016","journal-title":"Gynecol. Oncol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Spagnol, G., Bigardi, S., Zorzi, M., Morotti, M., Carollo, M., Bruni, G.M., De Tommasi, O., Tamagnini, M., Xhindoli, L., and Noventa, M. (2024). \u0394-Peritoneal Cancer Index (\u0394-PCI) to Predict Complete Cytoreduction and Histopathological Response to Neoadjuvant Chemotherapy in Ovarian Cancer. J. Clin. Med., 13.","DOI":"10.2139\/ssrn.4836444"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"4065","DOI":"10.1200\/JCO.22.02765","article-title":"Survival Effect of Maximal Cytoreductive Surgery for Advanced Ovarian Carcinoma During the Platinum Era: A Meta-Analysis","volume":"41","author":"Bristow","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"7413","DOI":"10.1038\/s41467-023-42712-6","article-title":"Indocyanine green fluorescence imaging-guided versus conventional laparoscopic lymphadenectomy for gastric cancer: Long-term outcomes of a phase 3 randomised clinical trial","volume":"14","author":"Chen","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S1470-2045(06)70665-9","article-title":"Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: A randomised controlled multicentre phase III trial","volume":"7","author":"Stummer","year":"2006","journal-title":"Lancet Oncol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S1479-666X(09)80108-X","article-title":"Primary peritonectomy\/HIPEC for disseminated peritoneal adenomucinosis achieves much lower recurrence rates and better survival than secondary procedures","volume":"7","author":"Zhu","year":"2009","journal-title":"Surgeon"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/BF02237250","article-title":"Prognostic value of microscopic peritoneal dissemination: Comparison between colon and gastric cancer","volume":"43","author":"Vogel","year":"2000","journal-title":"Dis. Colon. Rectum"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"2103","DOI":"10.1016\/j.ejso.2019.06.021","article-title":"Clinico-pathological outcomes after total parietal peritonectomy, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in advanced serous papillary peritoneal carcinoma submitted to neoadjuvant systemic chemotherapy- largest single institute experience","volume":"45","author":"Deraco","year":"2019","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.ejso.2019.02.031","article-title":"A comparison of outcomes following total and selective peritonectomy performed at the time of interval cytoreductive surgery for advanced serous epithelial ovarian, fallopian tube and primary peritoneal cancer\u2014A study by INDEPSO","volume":"47","author":"Sinukumar","year":"2021","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13048-024-01401-8","article-title":"A randomized controlled trial to compare short-term outcomes following infragastric and infracolic omentectomy at the time of primary debulking surgery for epithelial ovarian cancer with normal-appearing omentum","volume":"17","author":"Dong","year":"2024","journal-title":"J. Ovarian Res."},{"key":"ref_67","first-page":"325","article-title":"Prognostic factors in early-stage ovarian cancer","volume":"7","author":"Tognon","year":"2013","journal-title":"Ecancermedicalscience"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1007\/s11912-020-0883-2","article-title":"Lymphadenectomy in Ovarian Cancer: Is It Still Justified?","volume":"22","author":"Giannini","year":"2020","journal-title":"Curr. Oncol. Rep."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1056\/NEJMoa1808424","article-title":"A Randomized Trial of Lymphadenectomy in Patients with Advanced Ovarian Neoplasms","volume":"380","author":"Harter","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1245\/s10434-018-6453-2","article-title":"Intraoperative Pancreatic Cancer Detection using Tumor-Specific Multimodality Molecular Imaging","volume":"25","author":"Tummers","year":"2018","journal-title":"Ann. Surg. Oncol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e9418","DOI":"10.1002\/ccr3.9418","article-title":"Cardiophrenic lymph node metastasis as the sole presentation of high grade serous ovarian carcinoma","volume":"12","author":"Henning","year":"2024","journal-title":"Clin. Case Rep."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"e2417775","DOI":"10.1001\/jamanetworkopen.2024.17775","article-title":"Primary Cytoreduction and Survival for Patients With Less-Common Epithelial Ovarian Cancer","volume":"7","author":"Matsuo","year":"2024","journal-title":"JAMA Netw. Open"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Bonsang-Kitzis, H., Panchbhaya, N., Bats, A.S., Pujade-Lauraine, E., Pautier, P., Ng\u00f4, C., Le Fr\u00e8re-Belda, M.A., Kalbacher, E., Floquet, A., and Berton-Rigaud, D. (2022). Surgical Implications of Advanced Low-Grade Serous Ovarian Cancer: Analysis of the Database of the Tumeurs Malignes Rares Gyn\u00e9cologiques Network. Cancers, 14.","DOI":"10.3390\/cancers14092345"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s10585-014-9658-1","article-title":"Ascites-induced shift along epithelial-mesenchymal spectrum in ovarian cancer cells: Enhancement of their invasive behavior partly dependant on \u03b1v integrins","volume":"31","author":"Carduner","year":"2014","journal-title":"Clin. Exp. Metastasis"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"475","DOI":"10.4081\/oncol.2020.475","article-title":"Epithelial-mesenchymal interconversions in ovarian cancer: The levels and functions of E-cadherin in intraabdominal dissemination","volume":"14","author":"Roque","year":"2020","journal-title":"Oncol. Rev."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Todeschini, P., Salviato, E., Romani, C., Raimondi, V., Ciccarese, F., Ferrari, F., Tognon, G., Marchini, S., D\u2019Incalci, M., and Zanotti, L. (2021). Comprehensive Profiling of Hypoxia-Related miRNAs Identifies miR-23a-3p Overexpression as a Marker of Platinum Resistance and Poor Prognosis in High-Grade Serous Ovarian Cancer. Cancers, 13.","DOI":"10.3390\/cancers13133358"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.neo.2017.04.002","article-title":"Heterogeneous Cadherin Expression and Multicellular Aggregate Dynamics in Ovarian Cancer Dissemination","volume":"19","author":"Klymenko","year":"2017","journal-title":"Neoplasia"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/3\/410\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:36:32Z","timestamp":1759919792000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/3\/410"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,26]]},"references-count":77,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["cancers17030410"],"URL":"https:\/\/doi.org\/10.3390\/cancers17030410","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,26]]}}}