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Published on: January 22, 2022
Minimally invasive versus open interval debulking surgery for advanced epithelial ovarian cancer: a BMI-stratified
Haoyue Liu1, Lin Xiao1, Wenman Li1
1Department of Obstetrics and Gynecology, Chongqing Key Laboratory of Maternal and Fetal Medicine / Joint International Research Laboratory of Reproduction & Development, Ministry of Education / The Innovation and Talent Recruitment Base of Maternal-Fetal Medicine, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Objective:
This study aimed to evaluate the surgical outcomes of patients with advanced epithelial ovarian cancer (AEOC) across different body mass index (BMI) levels, who underwent either open surgery or minimally invasive surgery (MIS) for interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT).
Methods:
Patients diagnosed with stage III and IV AEOC between March 2014 and March 2024, who received IDS post-NACT, were enrolled and divided into open and minimally invasive (including laparoscopic and robot-assisted) surgery groups, and stratified by BMI for comparisons of surgical outcomes.
Results:
A total of 256 patients were enrolled. Following 1:1 propensity score matching, progression-free (PFS, p = 0.379) and overall survival (OS, p = 0.772) did not differ between the open surgery and MIS groups. In patients with BMI ≥ 24 kg/m2, the MIS group had lower intraoperative blood loss (p = 0.005), shorter postoperative flatus time (p = 0.020), lower iatrogenic bowel injury rates (p = 0.014), and higher R0 resection rates (p = 0.023) compared with the open surgery group, but no statistically significant OS difference was observed between MIS and open surgery groups.
Conclusion:
The study suggests that MIS is a feasible and safe alternative for carefully selected overweight and obese patients with AEOC, offering perioperative advantages without compromising long-term oncological outcomes. While MIS was associated with higher R0 rates in this subgroup, the benefits must be interpreted cautiously due to inherent selection biases.
