To evaluate the effect of surgical approach on overall survival (OS) for women with advanced, epithelial ovarian cancer (EOC) following neoadjuvant chemotherapy (NACT) and determine the socio-demographic and clinical factors associated with surgical approach.
The primary exposure was surgical approach to interval cytoreduction, minimally invasive versus open, and was evaluated by intention to treat. Primary outcome was OS. Associations were examined using Chi-squared tests, Wilcoxon rank sum tests, and multivariate logistic regression. Survival analysis was performed with Kaplan-Meier methods and Cox proportional hazards.
The National Cancer Database was used to identify women diagnosed with stage IIIC/IV EOC from 2010-2016.
Patients were included if they were treated with NACT within 90 days of diagnosis prior to interval cytoreductive surgery (CRS).
8,085 women were identified; 6,713 (83%) underwent open interval CRS and 1,372 (17%) underwent minimally invasive interval CRS. The proportion undergoing minimally invasive CRS after NACT increased from 2% in 2010 to 11% in 2016, a nearly 6-fold increase. There was no difference in OS between women who underwent minimally invasive and open interval CRS (median OS 36.5 vs 35.2 months, HR 0.94, 95% CI 0.86-1.04). After adjusting for demographic and clinical variables, including age, race, ethnicity, income, and Charlson/Deyo score, no difference in OS was observed (HR 0.95, 95% CI 0.86-1.04). Women of older age (OR 1.35, 95% CI 1.05-1.74) and Hispanic ethnicity (OR 1.46, 95% CI 1.14-1.88) had increased odds of receiving minimally invasive CRS following NACT, while low income (<$38,000/year) women had decreased odds (OR 0.76, 95% CI 0.60-0.97, p=0.03). Length of stay differed for patients undergoing minimally invasive versus open interval CRS (3 vs 5 days, p<0.01), but there was no difference in need for postoperative readmission.
Minimally invasive CRS has similar survival outcomes to open CRS among women with EOC who have undergone NACT.

Copyright © 2021. Published by Elsevier Inc.

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