Patients with advanced ovarian cancer may live longer if they undergo minimally invasive surgery (MIS) rather than laparotomy, according to a retrospective study presented at the 2023 SGO Annual Meeting on Women’s Cancer.
In this study, patients who underwent MIS had lower rates of mortality at 30 days and 90 days as well as longer median overall survival (OS) than patients who underwent laparotomy.
The study included 7897 patients from the National Cancer Database who had stage IIIC-IV epithelial ovarian cancer. They received neoadjuvant chemotherapy and underwent MIS or laparotomy between 2013 and 2018.
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The data showed an increase in MIS use during the period studied. In 2013, 20% of debulking surgeries were MIS. By 2018, that number had risen to 29%.
To balance differences between the cohorts, the researchers matched 2021 patients who underwent MIS with 2021 patients who underwent laparotomy.
The median OS was significantly longer in the MIS group than in the laparotomy group — 46.7 months and 41.0 months, respectively (hazard ratio, 0.86; 95% CI, 0.79-0.94; P <.01). However, there were no differences in OS when the researchers excluded converted procedures or included only patients with serous and endometrioid disease.
The rate of additional cytoreductive procedures was lower with MIS than with laparotomy (59.3% and 70.8%, respectively; P <.01). The proportion of patients with no residual disease was higher in the MIS group than in the laparotomy group (43.2% and 38.6%, respectively; P =.01).
Patients who underwent MIS had a lower 30-day mortality rate than patients who underwent laparotomy (0.3% and 0.7%, respectively; P =.04). The 90-day mortality rate was lower in the MIS group as well (1.4% vs 2.5%; P =.01).
In addition, patients who underwent MIS were hospitalized for a shorter period than patients who underwent laparotomy (median, 3.0 days and 5.0 days, respectively; P <.01).
“We found that minimally invasive surgery is increasingly being used for interval debulking surgery in advanced ovarian cancer,” said study presenter Kirsten Jorgensen, MD, of The University of Texas MD Anderson Cancer Center in Houston.
“And we found that it was not associated with higher mortality than laparotomy and had a lower morbidity profile. Nonetheless, prospective data are necessary.”
Disclosures: Dr Jorgensen reported having no conflicts of interest.
Reference
Jorgensen K, Wu CF, Nitecki R, et al. Laparotomy versus minimally invasive surgery for interval debulking surgery among patients with advanced ovarian cancer. SGO 2023. March 25-28, 2023.
