Minimally invasive surgery may be effective for advanced epithelial ovarian cancer
Click Here to Manage Email Alerts
Minimally invasive interval debulking surgery may benefit women with advanced epithelial ovarian cancer who received neoadjuvant chemotherapy, findings presented at Society of Gynecologic Oncology Annual Meeting on Women’s Cancer showed.
Surgical outcomes among women who underwent minimally invasive procedures appeared superior to those who underwent open surgery. Researchers who conducted the retrospective cohort study reported no difference in oncologic outcomes.
“This hopefully paves the way for a future prospective randomized trial evaluating mode of interval debulking surgery,” researcher Alice P. Barr, MD, third-year OB/GYN resident at Carolinas Medical Center, said during a presentation.
Neoadjuvant chemotherapy is used more frequently for women with advanced epithelial ovarian cancer; however, the optimal approach for interval debulking surgery has not been established.
“For decades, the standard of care for the treatment of advanced epithelial ovarian cancer has been upfront surgery followed by platinum-based chemotherapy,” Barr said during a presentation. “Now, however, we are seeing increasing treatment with neoadjuvant chemotherapy followed by interval debulking surgery. While this interval debulking surgery has traditionally been performed using open techniques, minimally invasive surgery offers multiple advantages.”
However, data regarding oncologic outcomes of minimally invasive vs. open interval debulking surgery are limited.
A preliminary single-institution study conducted at Levine Cancer Institute showed a minimally invasive approach was feasible and potentially effective for interval debulking surgery after neoadjuvant chemotherapy among women with epithelial ovarian cancer, with enhanced perioperative outcomes.
Barr and colleagues conducted their study to compare surgical and oncologic outcomes of minimally invasive and open surgery for women with advanced epithelial ovarian cancer who underwent interval debulking surgery after neoadjuvant chemotherapy.
The analysis included 415 consecutive women with stage III or stage IV epithelial ovarian cancer who received three to six cycles of neoadjuvant chemotherapy followed by minimally invasive (n = 122) or open (n = 293) interval debulking surgery from January 2008 through May 2019 at three tertiary care centers. Nearly twice as many women in the minimally invasive group underwent robotic surgery vs. traditional laparoscopy (64% vs. 36%).
Researchers reported no significant differences between the minimally invasive and open surgery groups with regard to disease stage or grade, average age at diagnosis (65.3 years vs. 63.2 years), or CA-125 level at diagnosis (2,247 U/mL vs. 3,145 U/mL) or after completion of neoadjuvant chemotherapy (179.1 U/mL vs. 251.7 U/mL).
However, women in the minimally invasive surgery cohort had lower average BMI (27 kg/m2 vs. 29 kg/m2; P = .009) and underwent fewer cycles of adjuvant chemotherapy (3 vs. 3.4; P = .01).
A higher percentage of procedures in the minimally invasive surgery group than open group were classified as low-complexity surgeries as determined by the Aletti surgical complexity scale (81% vs. 64%; P < .001).
“This may suggest that patients with a better prognosis tended to be chosen for minimally invasive surgery,” Barr said.
Women who underwent open surgery had significantly higher estimated blood loss (326.2 cc vs. 181.5 cc; P < .001) and were significantly more likely to require intraoperative transfusion (25% vs. 4%; P < .001). They also required a longer average hospital stay (5.9 days vs. 2.2 days; P < .001) and were more than twice as likely to experience a complication within 30 days of surgery (43% vs. 20%; P < .001).
Researchers reported no significant differences between the open surgery and minimally invasive groups with regard to operative time (191.1 minutes vs. 196.3 minutes) or 30-day hospital readmission rate (10% vs. 6%).
Results of the oncologic outcomes analysis — based on median follow-up of 33 months for the minimally invasive group and 36 months for the open surgery group — showed significantly higher R0 (66% vs. 46%; P < .001) and optimal (93% vs. 84%; P = .02) debulking rates in the minimally invasive group.
Researchers observed a trend toward a higher recurrence rate 24 months after diagnosis among women who underwent open surgery (70% vs. 60%), but this difference did not reach statistical significance.
Results showed no statistically significant differences between the minimally invasive and open surgery groups in median PFS (18.2 months vs. 15.1 months) or OS (40.9 months vs. 36.7 months).
Researchers acknowledged several potential study limitations, including its retrospective design, the fact most robotic cases were performed at a single institution, and the potential that the data may be difficult to generalize based on variable surgical expertise with minimally invasive surgical techniques, Barr said.
“Although the data could imply patients with better prognosis were chosen for the minimally invasive surgery group, this is not necessarily a limitation,” Barr said. “Our study reflects real-world parameters, where patients who are likely to have the best outcomes are selected for minimally invasive surgery.”
Collapse
Brown J, et al. Abstract 11284. Presented at: Society of Gynecologic Oncology Annual Meeting on Women’s Cancer (virtual meeting); March 19-25, 2021.
Click Here to Manage Email Alerts