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

Objectives: 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. Methods: 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. Download : Download high-res image (107KB) Download : Download full-size image Results: 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 Conclusions: 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.