A multi-institutional study of minimally invasive surgery compared to laparotomy for interval debulking after neoadjuvant chemotherapy in women with advanced ovarian cancer

Brown, Jubilee Barr Alice Zhang Yingao Davidson Brittany Secord Angeles Alvarez Drury Lane Crane Erin Tait David Naumann R. Wendel McNally Leah

Neoadjuvant chemotherapy (NAC) is becoming more ubiquitous for treatment of advanced epithelial ovarian cancer (EOC), and mode of interval debulking surgery (IDS) has not been adequately evaluated. A minimally invasive surgical (MIS) approach offers several advantages to an open approach (O-IDS), especially in the current COVID-19 pandemic, but data regarding outcomes are limited. We sought to compare the surgical and oncologic outcomes of MIS and O-IDS in patients (pts) with advanced EOC. All consecutive patients with stages III to IV EOC who underwent NAC followed by IDS from 2008-2018 at 3 tertiary care centers were included in this retrospective cohort study. Demographic, clinical, and pathologic factors were abstracted from electronic medical records. Progression-free survival (PFS) and overall survival (OS) were analyzed on a Kaplan-Meier estimator using the log-rank method, and Cox proportional hazards regression models were used for univariate and multivariate survival analyses. [Display omitted] A total of 415 pts underwent IDS through MIS (n=122;robotic = 78, laparoscopic = 44), or O-IDS (n=293). There were no statistically significant differences between age at diagnosis (O-IDS 63.2, MIS 65.3;p=0.1), stage (p=0.3), and grade (p=0.06). There were also no differences between CA-125 levels measured at diagnosis (O-IDS 3145 U/mL, MIS 2247 U/mL;p=0.2) or after completion of NACT (O-IDS 251.7 U/mL, MIS 179.1 U/mL;p=0.4) between the 2 groups. MIS was completed without conversion in 84 of 122 patients (68.8%), with most conversions occurring in the robotic group. Patients undergoing MIS had significantly fewer complex surgeries, with 81% of the cases categorized as low complexity when scored using the Aletti SCS, compared to 64% of open surgeries (p<0.001). Patients undergoing open surgeries had significantly higher estimated blood loss (EBL;326.2cc vs 181.5cc;p<0.001) and intraoperative transfusion rate (25% vs 4%;p<0.001). These patients also had a longer hospital length of stay (5.9 days vs 2.2 days;p<0.001) as well as 30-day postoperative complication rate (43% vs 20%, p<0.001). There were no observed differences between the 2 groups in terms of operative time (191.1 minutes vs 196.3 minutes;p=0.5) and 30-day hospital readmission rates (10% vs 6%;p=0.2). With regard to surgical cytoreduction, patients undergoing MIS had significantly higher rates of both R0 (66% vs 46%;p<0.001) and optimal, or R0/R1 (93% vs 84%;p=0.02) debulking rates. Patients undergoing open surgery trended towards having a higher rate of recurrence at 24 months after diagnosis, but this difference did not reach significance (70% vs 60%;p=0.06). Finally, there were no differences in the 2 groups in terms of PFS or OS (Figure 2). Median PFS was 15.1 months for O-IDS and 18.2 months for MIS (p=0.051). Median OS was 36.7 months for O-IDS and 40.9 months for MIS (p=0.5). MIS is a feasible and potentially effective mode of IDS after NAC in patients with advanced EOC. Surgical outcomes appear to be advantageous in MIS compared with O-IDS, and oncologic outcomes appear to be no different. Further investigation of robotic MIS compared with laparoscopic MIS for IDS is warranted. [ABSTRACT FROM AUTHOR] Copyright of Gynecologic Oncology is the property of Academic Press Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)