Laparoscopic Interval Debulking Surgery for Advanced Ovarian Cancer after Neoadjuvant Chemotherapy
Kirsten Jorgensen1, Leslie Bradford2, Victoria Wang1, Hong Chang1, John Schorge1 1 Tufts Medical Center 2 Maine Medical Center
Background:
Equivalent survival has been demonstrated among women with advanced ovarian cancer who receive neoadjuvant chemotherapy followed by interval debulking surgery as compared to upfront vertical laparotomy. Disease response at time of surgery indicates minimally invasive surgery (MIS) approach may be feasible.
Methods:
The National Cancer Database was used to identify a cohort of patients diagnosed with stage III or IV epithelial ovarian cancer between 2013 -2016 who received neoadjuvant chemotherapy followed by surgery. Cases were separated into minimally invasive (robotic and laparoscopic) and laparotomy approaches. Analysis was intention-to-treat.
Results:
4367 cases fit criteria. 414 (9.5%) underwent robotic surgery, 633 (14.5%) underwent laparoscopic surgery, for a total of 24% via MIS approach, a significant increase compared to prior studies. There was no difference in overall survival. There was a trend toward improved survival overall in New England. MIS surgeries had shorter hospitalizations post-operatively. Facility type appeared significantly different with MIS approach utilized in 32% of comprehensive community programs vs. 20% at academic institutions.
Conclusion:
MIS approach to interval debulking surgeries appears to be gaining popularity.
Results
of this study are consistent with prior studies, demonstrating non-inferiority of minimally invasive versus laparotomy procedures for optimal debulking and overall survival. Further analysis is necessary to investigate causes for trend toward New England’s improved survival.
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