Robotic vs laparoscopic interval cytoreductive surgery in stage III ovarian cancer: an analysis of the National...

Minimally invasive surgery for interval cytoreduction in advanced ovarian cancer has been associated with improved peri-operative outcomes without compromising survival; however, comparative data between robotic and laparoscopic approaches remain limited. We conducted a retrospective cohort study using the National Cancer Database, including patients with stage III high-grade serous ovarian cancer who underwent minimally invasive cytoreduction between 2010 and 2022. Patients were stratified by surgical platform (robotic vs laparoscopic). The primary outcome was overall survival, analyzed using Kaplan-Meier estimates and multivariable Cox regression adjusted for demographic, clinical, and facility-level factors. Among 2993 patients, 1718 (57.4%) underwent laparoscopy and 1275 (42.6%) robotic surgery; conversion to laparotomy occurred in 14.9% and 4.0%, respectively, p < .001. Median follow-up was 35 months (range; 3-166). Median overall survival was similar between robotic and laparoscopic groups (48.0 vs 45.0 months; p = .57), and surgical platform was not associated with overall survival on multivariable analysis (adjusted hazard ratio 0.95, 95% confidence interval 0.85 to 1.07). Robotic surgery was associated with shorter length of stay (2.2 vs 4.5 days, p = .001), this remained significant after adjusting for year of surgery, and lower conversion rates, with no differences in readmission or short-term mortality. These findings support both platforms as viable minimally invasive options in selected patients.