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; P = .17).