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

Kirsten Jorgensen, Alexander Melamed, Chi Fang Wu, Roni Nitecki, Rene Pareja, Anna Fagotti, John O. Schorge, Pedro T. Ramirez, Jose Alejandro Rauh-Hain

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: Patients who undergo IDS by MIS have similar overall survival and decreased morbidity compared with laparotomy.

Original languageEnglish (US)
Pages (from-to)130-137
Number of pages8
JournalGynecologic oncology
StatePublished - May 2023


  • Interval debulking
  • Laparoscopic surgery
  • Minimally invasive surgery
  • Ovarian cancer
  • Cytoreduction Surgical Procedures/methods
  • Humans
  • Ovarian Neoplasms/drug therapy
  • Carcinoma, Ovarian Epithelial/drug therapy
  • Female
  • Neoadjuvant Therapy
  • Retrospective Studies
  • Chemotherapy, Adjuvant
  • Neoplasm Staging
  • Minimally Invasive Surgical Procedures

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology


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