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890 Minimizing futile laparotomies at primary cytoreduction for advanced ovarian cancer: a feasibility study comparing management algorithms
  1. Ryan Matthew Kahn1,
  2. Kaothar Oladojaa1,
  3. Effi Yeoshoua1,
  4. Yulia Lakhman1,
  5. Debra Sarasohn1,
  6. Nadeem R Abu-Rustum2,
  7. Ginger Gardner2,
  8. Yukio Sonoda2,
  9. Oliver Zivanovic2,
  10. Kara Long Roche1 and
  11. Dennis Chi2
  1. 1Memorial Sloan Kettering Cancer Center, New York, USA
  2. 2Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, USA


Introduction/Background Our primary objective was to compare outcomes using two different published management algorithms for the triage of patients with advanced ovarian cancer (OC) to primary debulking surgery (PDS) versus diagnostic laparoscopy (LSC) or neoadjuvant chemotherapy (NACT).

Methodology This feasibility study was conducted from 07/01/2021 to 10/31/2023 and included prospectively identified patients with suspected advanced OC who underwent management at our institution. Utilizing a standardized radiology synoptic report, patients underwent the calculation of a resectability score (RS) prior to the decision on primary management of PDS vs. LSC or NACT.

Results 150 patients were included. 77% of patients (115/150) had RS1 low-risk scores and 23% (35/150) RS1 high-risk, vs. 72% (108/150) RS2 low-risk and 28% (42/150) RS2 high-risk (p=0.4). Among low-risk RS1 patients who underwent PDS, the optimal rate was 95% (93/98) with CGR achieved in 84% (82/98); suboptimal in 5% (5/98), vs. low-risk RS2 the optimal rate was 95% (93/98) with CGR achieved in 82% (80/98); suboptimal in 5% (5/98) (p=0.3). Among high-risk RS1 patients, the optimal rate was 92% (11/12) with CGR achieved in 58% (7/12); suboptimal in 8% (1/12); high-risk RS2, the optimal rate was 92% (11/12) with CGR achieved in 75% (9/12); suboptimal in 8% (1/12) (p>0.05). 27% of patients (40/150) did not have a PDS (17 low risk RS1, 23 high risk RS1; 10 low risk RS2, 30 high risk RS2); 29 had a diagnostic LSC then NACT and 11 went directly to NACT. Among 11 physicians surveyed, 100% preferred RS2 as compared to RS1 in ease of use and time to completion.

Conclusion Implementation of the RS2 algorithm led to a futile laparotomy rate of 5% and a CGR rate of 81% (95% optimal resections). RS2 demonstrated no significant differences in predicting a suboptimal resection when compared to RS1; RS2 was favorable among physicians surveyed.

Disclosures I, Ryan Kahn, have no disclosures. See COI forms for full authorship disclosures.

Abstract 890 Figure 1

(A) RS1 scoring algorithm, total score calculated as sum of scores for each variable if present with size criteria met on pre-operative imaging. (B) RS2 scoring algorithm. (C) RS1 patient flow diagram from study based on score. (D) RS2 patient flow diagram from study based on score

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