Compare survival between patients with advanced epithelial ovarian cancer (EOC) undergoing interval debulking surgery (IDS), comparing robotic-assisted (R-IDS) and open (O-IDS) approach. Secondarily, we will assess the impact of adjuvant and neoadjuvant chemotherapy (NACT) cycles as independent variables associated with survival in this patient population.
Retrospective cohort study.
Single tertiary-care center.
93 patients diagnosed with advanced EOC who underwent NACT prior to primary debulking surgery following consultation with a gynecologic oncologist.
All patients underwent IDS after completion of NACT with either R-IDS or O-IDS between 2011-2018 at a single tertiary-care center. Exclusion criteria included receiving less than 3 or more than 6 cycles of NACT, or concurrent diagnoses of other malignancies during the treatment period.
93 patients were identified (n=43 R-IDS; n=50 O-IDS). Median age (63.0 v 66.2) did not differ between the two groups (p=0.1). 91% of patients were optimally cytoreduced (57% R0, 34% R1), and R0 rate was not influenced by surgical modality (52% O-IDS v 63% R-IDS, p=0.4). Progression-free survival (PFS) and overall survival (OS) did not differ between patients undergoing O-IDS and R-IDS (PFS 15.4 v 16.7 m, p=0.7; OS 38.2 v 35.6 m, p=0.7). Cytoreduction to R0 improved both PFS and OS independent of surgical approach. Subgroup analysis showed that specifically in R-IDS patients, receiving >6 total cycles of chemotherapy was independently associated with both decreased PFS (HR 3.85, 95% CI 1.52-9.73) and OS (HR 3.97, 95% CI 1.08-14.59). When separately analyzed, neither NACT or adjuvant cycle numbers had any effect on survival.
In this retrospective study of patients with advanced EOC undergoing IDS after NACT, use of robotic-assisted surgery did not impact debulking success or oncologic survival indices. Receiving >6 total cycles of chemotherapy prior to IDS was associated with a decrease in both PFS and OS in patients undergoing R-IDS in this cohort and warrants further investigation.

Copyright © 2020. Published by Elsevier Inc.