Feasibility and safety of minimally invasive technology for interval cytoreductive surgery during advanced ovarian cancer after neoadjuvant chemotherapy

Abstract

Ovarian cancer (OV) is usually diagnosed in its advanced stages (stages III or IV), minimally invasive surgery (MIS) is increasingly being used to treat advanced OV due to several advantages over laparotomy. MIS represents a novel but controversial treatment approach for interval debulking surgery (IDS). The objective of this review was to clarify the feasibility and safety of MIS for IDS. WanFang database, Chinese National Knowledge Infrastructure (CNKI) databases, Embase, PubMed, Cochrane, Clinicaltrials.gov and Web of Science were searched up to June 2022, Clinical studies based on humans, including randomized controlled trials, quasi-RCTs, non-randomized trials, case-control studies, cohort studies and retrospective observational studies, were included without time restriction. 14 original articles published between 2015 and 2022 were included. In total, there were 13,788 patients enrolled, 2318 (16.8%) were treated with MIS. The pooled rate of laparotomy-conversion was 17.9%(112/711), the pooled rate of optimal cytoreduction was 84.0% (628/748) during MIS group compared with 77.3% (2204/2850) during laparotomy (LAP) group (p < 0.0001), and the pooled rate of perioperative complication was 8.85% (79/893) during MIS versus 4.6% (211/4586) during LAP group (p < 0.0001). We found no significant difference in mean progression-free survival (PFS) and mean overall survival (OS) between two groups. Based on the available retrospective studies, minimally invasive debulking surgery after NACT seemed to have similar perioperative, oncological and prognostic outcomes with laparotomy debulking surgery. MIS seemed to be feasible and safe in carefully selected patients who had good response to NACT, lower preoperative levels of CA12-5 and lower tumor burden. However, existed clinical evidence should be viewed with caution and objectivity. MIS for IDS should be cautiously suggested until the observed results are confirmed in the LANCE trial and other larger prospective trials.