Judy Hayek, MD, explains the rationale of a retrospective analysis evaluating laparoscopic vs open surgery in advanced ovarian cancer.

Dr Hayek on the Rationale of Assessing Laparoscopic Surgery in Advanced Ovarian Cancer

“Primary debulking surgery has been the mainstay [in the] management of ovarian cancer. Current recommendations by the Society of Gynecologic Oncology suggest that select patients who have a high perioperative risk profile and/or significant disease burden could qualify for neoadjuvant chemotherapy, where we give them chemotherapy up-front and then attempt interval debulking surgery.”

Judy Hayek, MD, gynecologic oncology fellow, State University of New York (SUNY) Downstate College of Medicine, explains the rationale of a retrospective analysis evaluating laparoscopic vs open surgery in advanced ovarian cancer.

Standard treatment for managing advanced ovarian cancer has been primary debulking surgery, Hayek says. Recommendations by the Society of Gynecologic Oncology (SGO) suggest that patients could qualify for neoadjuvant chemotherapy if they have a high perioperative risk profile or significant disease burden, she notes.

The retrospective study included 2412 patients with advanced ovarian cancer who had undergone R0 resection at the time of interval debulking surgery. Of note, 25.9% of patients underwent minimally invasive surgery; 74.1% underwent open surgery or converted from minimally invasive surgery to open surgery. Specifically, among patients in the minimally invasive surgery group, 48.7% underwent robotic procedures, and 51.3% underwent laparoscopic procedures.

Hayek also explains that the National Comprehensive Cancer Network (NCCN) does not currently have clear guidelines on approaches to interval debulking surgery in ovarian cancer. However, the NCCN does recommend that select patients undergo minimally invasive surgery at the time of interval debulking surgery, she clarifies.

Overall survival (OS) after interval R0 resection was the primary end point of the retrospective analysis. Hayek and colleagues did not find a difference in OS between the open and minimally invasive surgery groups. The median OS was 46 months in the open surgery group vs 51 months in the minimally invasive surgery group (IPTW HR, 1.10; 95% CI, 0.94-1.26; 

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Dr Hayek on Laparoscopic vs Open Surgery in Advanced Ovarian Cancer

Judy Hayek, MD, gynecologic oncology fellow, State University of New York (SUNY) Downstate College of Medicine, discusses findings regarding hospital readmission rates and mortality rates from a study comparing outcomes of minimally invasive vs open interval complete gross resection (R0) in patients with advanced ovarian cancer.

This study included 2412 patients who had undergone R0 resection at the time of interval debulking surgery, 25.9% of whom had undergone minimally invasive surgery (MIS) and 74.1% of whom had undergone open surgery or converted from MIS to open surgery. In the MIS group, 48.7% and 51.3% of patients underwent robotic and laparoscopic procedures, respectively.

Investigators observed no differences in stage, histology, and comorbidities between the population of patients who underwent MIS and those who underwent open surgery. However, the patients in the MIS group were more likely to be older than those in the open surgery group. Additionally, patients who underwent MIS were more likely to receive care at comprehensive community cancer centers located in metropolitan areas. Conversely, patients who underwent open surgery were more likely to receive extensive surgery, at 53% vs 41% in the MIS group (P < .001). This study also found that from 2010 to 2019, the rate of MIS use for interval debulking surgery increased from 11.9% to 36.5%, Hayek says.

The primary end point of this study was overall survival (OS) after interval R0 resection. Investigators found no OS difference between the open and MIS surgery groups, which achieved a median OS of 46 months and 51 months, respectively (IPTW HR, 1.10; 95% CI, 0.94-1.26; P = .17). Secondary end points in this study included hospital readmission rates, 30-day/90-day mortality rates, and length of postoperative hospital stay. Although patients in the MIS group required shorter postoperative hospital stays than those in the open surgery group, Hayek concludes.

Judy Hayek, MD, discusses outcomes with minimally invasive vs open interval complete gross resection in patients with advanced ovarian cancer.

Judy Hayek, MD

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Dr Hayek on the Rationale of Assessing Laparoscopic Surgery in Advanced Ovarian Cancer

Dr Hayek on Laparoscopic vs Open Surgery in Advanced Ovarian Cancer