Minimally invasive interval debulking surgery for advanced ovarian cancer after neoadjuvant chemotherapy. 2023

Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Electronic address: kajorgensen@mdanderson.org.

Assess outcomes of interval debulking surgery (IDS) after neoadjuvant chemotherapy via minimally invasive surgery (MIS) compared with laparotomy in patients with advanced epithelial ovarian cancer. Patients diagnosed with stage IIIC or IV epithelial ovarian cancer between 2013 and 2018 who received neoadjuvant chemotherapy and IDS were identified in the National Cancer Database. Primary outcome was overall survival. Secondary outcomes were 5-year survival, 30- and 90-day postoperative mortality, extent of surgery, residual disease, hospitalization duration, surgical conversions, and unplanned readmissions. Propensity score matching was used to compare MIS and laparotomy for IDS. Association of treatment approach with overall survival was assessed using Kaplan-Meier method and Cox regression. Sensitivity analysis was conducted for effect of unmeasured confounders. A total of 7897 patients met inclusion criteria; 2021 (25.6%) underwent MIS. Percentage undergoing MIS increased from 20.3%-29.0% over the study period. After propensity score matching, median overall survival was 46.7 months in the MIS group versus 41.0 months in the laparotomy group [hazard ratio (HR) 0.86 (95%CI 0.79-0.94)]. Five-year survival probability was higher in MIS versus laparotomy (38.3% vs 34.8%, p < 0.01). There was lower 30- and 90-day mortality (0.3% vs 0.7% [p = 0.04] and 1.4% vs 2.5% [p = 0.01], respectively), shorter length of stay (median 3 vs 5 days, p < 0.01), lower residual disease (23.9% vs 26.7%, p < 0.01), and lower additional cytoreductive procedures (59.3% vs 70.8%, p < 0.01) in MIS compared to laparotomy, with similar rates of unplanned readmission (2.7% vs 3.1%, p = 0.39). Patients who undergo IDS by MIS have similar overall survival and decreased morbidity compared with laparotomy.

UI MeSH Term Description Entries
D009367 Neoplasm Staging Methods which attempt to express in replicable terms the extent of the neoplasm in the patient. Cancer Staging,Staging, Neoplasm,Tumor Staging,TNM Classification,TNM Staging,TNM Staging System,Classification, TNM,Classifications, TNM,Staging System, TNM,Staging Systems, TNM,Staging, Cancer,Staging, TNM,Staging, Tumor,System, TNM Staging,Systems, TNM Staging,TNM Classifications,TNM Staging Systems
D010051 Ovarian Neoplasms Tumors or cancer of the OVARY. These neoplasms can be benign or malignant. They are classified according to the tissue of origin, such as the surface EPITHELIUM, the stromal endocrine cells, and the totipotent GERM CELLS. Cancer of Ovary,Ovarian Cancer,Cancer of the Ovary,Neoplasms, Ovarian,Ovary Cancer,Ovary Neoplasms,Cancer, Ovarian,Cancer, Ovary,Cancers, Ovarian,Cancers, Ovary,Neoplasm, Ovarian,Neoplasm, Ovary,Neoplasms, Ovary,Ovarian Cancers,Ovarian Neoplasm,Ovary Cancers,Ovary Neoplasm
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000077216 Carcinoma, Ovarian Epithelial A malignant neoplasm that originates in cells on the surface EPITHELIUM of the ovary and is the most common form of ovarian cancer. There are five histologic subtypes: papillary serous, endometrioid, mucinous, clear cell, and transitional cell. Mutations in BRCA1, OPCML, PRKN, PIK3CA, AKT1, CTNNB1, RRAS2, and CDH1 genes are associated with this cancer. Epithelial Ovarian Cancer,Epithelial Ovarian Carcinoma,Ovarian Cancer, Epithelial,Ovarian Epithelial Cancer,Ovarian Epithelial Carcinoma,Cancer, Epithelial Ovarian,Cancer, Ovarian Epithelial,Carcinoma, Epithelial Ovarian,Epithelial Cancer, Ovarian,Epithelial Carcinoma, Ovarian,Epithelial Ovarian Cancers,Epithelial Ovarian Carcinomas,Ovarian Carcinoma, Epithelial,Ovarian Epithelial Cancers,Ovarian Epithelial Carcinomas
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D017024 Chemotherapy, Adjuvant Drug therapy given to augment or stimulate some other form of treatment such as surgery or radiation therapy. Adjuvant chemotherapy is commonly used in the therapy of cancer and can be administered before or after the primary treatment. Adjuvant Chemotherapy,Drug Therapy, Adjuvant,Adjuvant Drug Therapy
D019060 Minimally Invasive Surgical Procedures Procedures that avoid use of open, invasive surgery in favor of closed or local surgery. These generally involve use of laparoscopic devices and remote-controlled manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device. Minimal Access Surgical Procedures,Minimal Surgical Procedures,Minimally Invasive Surgical Procedure,Surgical Procedures, Minimally Invasive,Minimal Surgical Procedure,Minimally Invasive Surgery,Procedure, Minimal Surgical,Procedures, Minimal Access Surgical,Procedures, Minimal Surgical,Procedures, Minimally Invasive Surgical,Surgical Procedure, Minimal,Surgical Procedures, Minimal,Surgical Procedures, Minimal Access,Minimally Invasive Surgeries,Surgeries, Minimally Invasive,Surgery, Minimally Invasive
D020360 Neoadjuvant Therapy Preliminary cancer therapy (chemotherapy, radiation therapy, hormone/endocrine therapy, IMMUNOTHERAPY, HYPERTHERMIA, INDUCED etc.) that is given before the main therapy. Neoadjuvant Chemoradiation,Neoadjuvant Chemoradiation Therapy,Neoadjuvant Chemoradiation Treatment,Neoadjuvant Chemoradiotherapy,Neoadjuvant Chemotherapy,Neoadjuvant Chemotherapy Treatment,Neoadjuvant Radiation,Neoadjuvant Radiation Therapy,Neoadjuvant Radiation Treatment,Neoadjuvant Radiotherapy,Neoadjuvant Systemic Therapy,Neoadjuvant Systemic Treatment,Neoadjuvant Treatment,Chemoradiation Therapy, Neoadjuvant,Chemoradiation Treatment, Neoadjuvant,Chemoradiation, Neoadjuvant,Chemoradiotherapy, Neoadjuvant,Chemotherapy Treatment, Neoadjuvant,Chemotherapy, Neoadjuvant,Neoadjuvant Chemoradiation Therapies,Neoadjuvant Chemoradiation Treatments,Neoadjuvant Chemoradiations,Neoadjuvant Chemoradiotherapies,Neoadjuvant Chemotherapies,Neoadjuvant Chemotherapy Treatments,Neoadjuvant Radiation Therapies,Neoadjuvant Radiation Treatments,Neoadjuvant Radiations,Neoadjuvant Radiotherapies,Neoadjuvant Systemic Therapies,Neoadjuvant Systemic Treatments,Neoadjuvant Therapies,Neoadjuvant Treatments,Radiation Therapy, Neoadjuvant,Radiation Treatment, Neoadjuvant,Radiation, Neoadjuvant,Radiotherapy, Neoadjuvant,Systemic Therapy, Neoadjuvant,Systemic Treatment, Neoadjuvant,Therapy, Neoadjuvant,Therapy, Neoadjuvant Chemoradiation,Therapy, Neoadjuvant Radiation,Therapy, Neoadjuvant Systemic,Treatment, Neoadjuvant,Treatment, Neoadjuvant Chemoradiation,Treatment, Neoadjuvant Chemotherapy,Treatment, Neoadjuvant Radiation,Treatment, Neoadjuvant Systemic
D065426 Cytoreduction Surgical Procedures Operative procedures carried out to reduce a mass of tissue, for example, to reduce the total amount of tissue composing a tumor. Cytoreductive Surgery,Cytoreductive Surgical Procedures,Debulking Surgical Procedures,Cytoreduction Surgical Procedure,Cytoreductive Surgeries,Cytoreductive Surgical Procedure,Debulking Surgical Procedure,Procedure, Cytoreduction Surgical,Procedure, Cytoreductive Surgical,Procedure, Debulking Surgical,Surgery, Cytoreductive,Surgical Procedure, Cytoreduction,Surgical Procedure, Cytoreductive,Surgical Procedure, Debulking,Surgical Procedures, Cytoreductive

Related Publications

Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
January 2019, Journal of minimally invasive gynecology,
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
March 2020, Archives of gynecology and obstetrics,
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
August 1991, Gynecologic oncology,
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
January 2019, Journal of minimally invasive gynecology,
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
December 2012, Chinese journal of cancer research = Chung-kuo yen cheng yen chiu,
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
January 2016, Archives of gynecology and obstetrics,
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
April 2020, Japanese journal of clinical oncology,
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
September 2011, European journal of cancer (Oxford, England : 1990),
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
September 2016, Expert review of anticancer therapy,
Kirsten Jorgensen, and Alexander Melamed, and Chi-Fang Wu, and Roni Nitecki, and Rene Pareja, and Anna Fagotti, and John O Schorge, and Pedro T Ramirez, and Jose Alejandro Rauh-Hain
August 2009, Gynecologic oncology,
Copied contents to your clipboard!