Minimally invasive interval debulking surgery for advanced ovarian cancer after neoadjuvant chemotherapy

Objective. Assess outcomes of interval debulking surgery (IDS) after neoadjuvant chemotherapy via mini-mally invasive surgery (MIS) compared with laparotomy in patients with advanced epithelial ovarian cancer.Methods. Patients diagnosed with stage IIIC or IV epithelial ovarian cancer between 2013 and 2018 who re-ceived neoadjuvant chemotherapy and IDS were identified in the National Cancer Database. Primary outcome was overall survival. Secondary outcomes were 5-year survival, 30-and 90-day postoperative mortality, extent of surgery, residual disease, hospitalization duration, surgical conversions, and unplanned readmissions. Propen-sity score matching was used to compare MIS and laparotomy for IDS. Association of treatment approach with overall survival was assessed using Kaplan-Meier method and Cox regression. Sensitivity analysis was conducted for effect of unmeasured confounders.Results. A total of 7897 patients met inclusion criteria; 2021 (25.6%) underwent MIS. Percentage undergoing MIS increased from 20.3%-29.0% over the study period. After propensity score matching, median overall survival was 46.7 months in the MIS group versus 41.0 months in the laparotomy group [hazard ratio (HR) 0.86 (95%CI 0.79-0.94)]. Five-year survival probability was higher in MIS versus laparotomy (38.3% vs 34.8%, p < 0.01). There was lower 30-and 90-day mortality (0.3% vs 0.7% [p = 0.04] and 1.4% vs 2.5% [p = 0.01], respectively), shorter length of stay (median 3 vs 5 days, p < 0.01), lower residual disease (23.9% vs 26.7%, p < 0.01), and lower additional cytoreductive procedures (59.3% vs 70.8%, p < 0.01) in MIS compared to laparotomy, with sim-ilar rates of unplanned readmission (2.7% vs 3.1%, p = 0.39).Conclusions. Patients who undergo IDS by MIS have similar overall survival and decreased morbidity com-pared with laparotomy.(c) 2023 Elsevier Inc. All rights reserved.

Automated summary

This study aimed to assess the outcomes of interval debulking surgery (IDS) after neoadjuvant chemotherapy via minimally invasive surgery (MIS) compared with laparotomy in patients with advanced epithelial ovarian cancer. The study found that patients who underwent IDS with MIS had similar overall survival and decreased morbidity compared with those who underwent laparotomy.