Introduction/Background*Standard treatment of advanced ovarian cancer is complete cytoreductive surgery, historically done by laparotomy, and survival is directly linked to the residual tumor at the end of surgery. When optimal upfront surgery is not achievable, neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) is an alternative. Laparoscopy as IDS for advanced ovarian cancer is controversial. We wanted to evaluate the feasibility of laparoscopic IDS compared to laparotomy by analyzing overall survival (OS) and progression free survival (PFS), as well as per and post-operative morbidity.
Methodology We conducted a retrospective cohort study and included patients with IDS avec neoadjuvant chemotherapy for advanced ovarian cancer. We included patients with stage III or IV FIGO (International Federation of Gynecology and Obstetrics) serous ovarian cancer who had no residual disease after IDS. We applied a propensity score to match patients on confounding factors.
Result(s)*We included 37 patients in the laparoscopy group and 40 in the laparotomy group, from the 1st of January 2009 to the 1st of June 2019. Median overall survival was 23.1 months (95% CI 15.7-29.7) and 26.3 months (95% CI 21.7-31.7) for women who underwent laparoscopy and laparotomy, respectively (p=0.17). Median PFS was 14.8 months (95% CI 10.6-21.5) for the laparoscopy group and 12 months (95% CI 11-15.1) for the laparotomy group (p=0.057). After applying the propensity score, we included 25 patients in each group with similar baseline characteristics. OS was modified with a HR of 0.45 (CI 95% 0.19-0.95) p = 0.04 in favor of laparoscopy. Laparotomy group had more early post-operative complications (17 versus 6 in the laparoscopy group, P=0.01) and a longer hospitalization time (7.5 days compared to 12.1 days, p<0.001).
Conclusion*Oncological outcome was better in patients with similar pre-operative characteristics who underwent laparoscopic IDS. Laparoscopic IDS is a safe alternative for laparotomy in selected patients and is associated with less post-operative morbidity.
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