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Minimally Invasive Surgery vs Open Laparotomy for Interval Debulking Surgery of Advanced Ovarian Cancer After Neoadjuvant Chemotherapy
Researchers indicate that controversy still persists with regard to the selection of minimally invasive surgery (MIS) or open laparotomy for ovarian cancer (OC) after neoadjuvant chemotherapy (NACT).
For interval debulking surgery (IDS) after NACT in patients with advanced OC, complete cytoreductive surgery with MIS is another reasonable and efficacious choice, according to study findings published in (Front Oncol. 2022; 12:900256. doi:10.3389/fonc.2022.900256).
Siyuan Zeng, MD, Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China and colleagues aimed to evaluate the efficacy and safety of MIS versus open laparotomy following neoadjuvant chemotherapy for advanced OC, so as to provide another option to select optimal surgical procedures for patients with OC.
Dr Zeng and colleagues conducted a meta-analysis by following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria. In order to examine the feasibility of MIS, this study systematically evaluated the comprehensive studies and compared the efficacy and safety of MIS and laparotomy in advanced patients with OC after NACT.
In this meta-analysis, six eligible literature studies, with 643 patients in the MIS group and 2885 patients in the open laparotomy group were included. No significant differences were identified in the overall survival (OS) of patients with OC who were treated with MIS or open laparotomy [hazard ratio (HR) = 0.85; 95% confidence interval (CI) = 0.59–1.23; heterogeneity: P = 0.051, I2 = 57.6%].
However, the progression-free survival (PFS) was significantly greater in patients with OC treated with MIS than those treated with laparotomy (HR = 0.73; 95% CI = 0.57 to 0.92; heterogeneity: P = 0.276, I2 = 22.4%). The completeness of debulking removal (R0 rate) in the open laparotomy group was not statistically higher compared with the control group (RR = 1.07; 95% CI = 0.93 to 1.23; heterogeneity: P = 0.098, I2 = 52.3%), and no significant differences in residual disease of ≤1 cm (R1) (RR = 1.08; 95% CI = 0.91 to 1.28; heterogeneity: P = 0.330, I2 = 12.6%) and postoperative complications were discovered between the two groups (RR = 0.72; 95% CI = 0.34 to 1.54; heterogeneity: P = 0.055, I2 = 60.6%). Additionally, the duration of stays in hospital was significantly less in patients with OC treated with MIS than those treated with open laparotomy (Standard Mean Difference (SMD) = −1.21; 95% CI = −1.78 to −0.64; heterogeneity: P < 0.001, I2 = 92.7%].
The authors concluded, “Our meta-analysis suggested that MIS for IDS is feasible and safe for selecting advanced patients with OC (for partial response or complete response after NACT, optimal cytoreduction can be accomplished).”
