Recurrence Patterns After Complete Cytoreduction for Advanced Ovarian Cancer: Robotic Versus Open Surgery

TL;DR

This study shows that robotic surgery for advanced ovarian cancer is as effective as open surgery in preventing cancer recurrence when no residual disease remains after surgery.

Contribution

The study provides evidence that robotic-assisted surgery does not alter recurrence patterns compared to open surgery in advanced ovarian cancer patients with complete cytoreduction.

Findings

Recurrence patterns were similar between robotic and open surgery in patients with complete cytoreduction.

Oncologic outcomes, including survival, were comparable between the two surgical approaches.

Robotic surgery was associated with longer disease-free and overall survival in this patient group.

Abstract

Robotic-assisted cytoreductive surgery is increasingly used in advanced ovarian cancer, but concerns remain about whether this minimally invasive approach affects the recurrence patterns compared to open surgery. This study compared the recurrence patterns and oncologic outcomes of patients with advanced epithelial ovarian cancer who achieved the best outcome attainable by surgery, namely, no residual disease. Oncologic outcomes were comparable between the two approaches, and, among those who recurred, the anatomical distribution of recurrence did not differ between robotic and open surgery. These findings suggest that robotic-assisted cytoreduction can be a safe and oncologically sound option in carefully selected patients who attain no residual disease.

Background: Complete cytoreduction remains the primary surgical objective in advanced ovarian cancer and concerns persist that robotic surgery may result in distinct recurrence patterns and worse oncologic outcomes due to technical limitations, such as the use of pneumoperitoneum, the restricted visualization, and the lack of tactile evaluation. Methods: We retrospectively identified 125 consecutive patients with advanced epithelial ovarian cancer who attained the best outcome surgery can achieve, and compared the outcome of these patients based on whether complete cytoreduction was achieved by laparotomy or robotic surgery. The primary objective was to compare recurrence patterns and secondary analyses assessed perioperative, postoperative, and survival outcomes. Results: Among 125 patients who had complete cytoreduction (78 robotic; 47 open), baseline characteristics were largely comparable, except for higher rates of interval cytoreduction (84.6% vs. 61.7%, p < 0.01) and more PARP inhibitor use (19.2% vs. 6.4%, p = 0.048) in the robotic group. Recurrence patterns did not differ. Operative and postoperative outcomes were likewise comparable. Median disease-free and overall survival were longer in the robotic group. Conclusions: Among patients achieving complete cytoreduction, recurrence patterns and oncologic outcomes were comparable between robotic and open surgery, suggesting that the route of attaining complete cytoreduction did not influence the outcome.

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