Overall Survival Following Interval Complete Gross Resection of Advanced Ovarian Cancer via Laparoscopy Versus Open Surgery: An Analysis of the National Cancer Database.
Academic Article
Overview
abstract
Background: Advanced epithelial ovarian cancer (EOC) has traditionally been treated with primary debulking surgery; however, recent phase III trials have demonstrated similar survival outcomes for patients who were randomized to neoadjuvant chemotherapy followed by interval debulking (IDS) when compared to patients who underwent PDS. Methods: We sought to evaluate a cohort of patients with EOC diagnosed between 2010 and 2019 who underwent complete cytoreduction (R0-no gross residual disease) during IDS. We compared the outcomes after R0 resection via MIS versus laparotomy in IDS. The primary endpoint was overall survival (OS). Kaplan-Meier analysis and inverse probability of treatment weighting (IPTW) were used. Cases were stratified by surgical extent and within the MIS cohort by robotic assistance. Surgical outcomes (LOS, readmission rate, 30- and 90-day mortality) were also assessed. Results: In total, 2412 patients were eligible. 624 (25.8%) underwent R0 resection via MIS. Over the study period, the MIS utilization rate increased from 12% to 36%. There was no significant difference in OS between the MIS and open cohorts (51 vs. 46 months, HR 1.1; 95% CI 0.96-1.24). 30-day and 90-day postoperative mortality rates were higher in the open group (1.6% vs. 0.8%, p = 0.006) and (1.9% vs. 3.5%, p = 0.003), respectively. Patients in the MIS group were less likely to undergo extensive surgery (41% vs. 53%, p < 0.001). When stratified by surgical extent, no significant difference in OS was observed between MIS and laparotomy (49 vs. 44 months in the extensive surgery group and 53 vs. 50 months in the non-extensive surgery group). Within the MIS cohort, 49% of cases were performed robotically. OS did not differ significantly between robotic and conventional laparoscopic cases (52 vs. 50 months). From 2010 to 2019, there was an increase in the use of robot-assisted laparoscopy (from 6.2% to 25.5%), coinciding with a decline in the laparotomy rate (from 88.1% to 63.5%) (p = 0.008). Conclusions: R0 resection via MIS during IDS showed similar OS and decreased postoperative mortality compared to laparotomy. The increasing utilization of robotic assistance is associated with a decrease in the laparotomy rate.
