Robotic interval debulking surgery for advanced epithelial ovarian cancer: current challenge or future direction? A syst
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REVIEW ARTICLE
Robotic interval debulking surgery for advanced epithelial ovarian cancer: current challenge or future direction? A systematic review Victoria Psomiadou1 · Anastasia Prodromidou1 · Alexandros Fotiou1 · Sofia Lekka1 · Christos Iavazzo1 Received: 15 July 2020 / Accepted: 30 September 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract We evaluated the effectiveness, safety and efficacy of robotic interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) treated with neoadjuvant chemotherapy (NACT). We conducted a systematic review of the published relevant studies. Α total of 102 patients were evaluated. Mean operative time ranged from 164 to 312 min (mean ± SD: 246 ± 61 min) while mean estimated blood loss ranged from 106.9 to 262.5 ml (mean ± SD: 168 ± 68 ml) and postoperative blood transfusion rate was 19% (n = 19/98). Complete cytoreduction rate (R0 resection) was achieved in 75 patients (76.5%), whereas residual disease ≤ 1 cm in 21 women (21.5%). Mean hospital stay was 2.4 days. No intraoperative and six postoperative (14.6%) complications were reported. Laparotomy conversion rate was 9.2% (9/98) mostly in the terms of achieving complete cytoreduction and 30-day mortality rate was 9.2% (n = 9/98). The median overall survival varied from 39.7 to 47.2 months, while the progression-free survival ranged from 20.6 to 21.2 months during a median follow-up period from 2 to 86 months (median 25.3 months). A total of 60 women (61%) developed disease recurrence. One of the studies reported significantly improved OS and PFS in patients who underwent robotic IDS when compared to those who had laparotomy either during or before the addition of robotic surgery in the management of advanced ovarian cancer disease (47.2 vs 37.8 vs 37.9, p = 0.004 for OS and 20.6 vs 13.9 vs 11.9, p = 0.005 for PFS, respectively). The same was also observed when controlling the parameters of age and stage for patients in the robotic arm (p = 0.02). Robotic interval debulking surgery can be considered in the management of advanced ovarian cancer patients after receiving neoadjuvant chemotherapy. Larger meta-analyses including multicenter randomized control trials are necessary to specify the exact profile of the patients that could benefit from this treatment strategy. Keywords Robotic surgery · Interval debulking surgery · Ovarian cancer
Introduction Ovarian cancer is one of the most common gynecological malignancies thus by far the most lethal. The high fatality rate is mainly attributed to the difficulty of early diagnosis, since the malignancy is typically lacking symptoms until it reaches advanced stages, where the prognosis and the 5-year survival rate are poor [1]. Management of ovarian cancer encompasses originally optimal cytoreduction surgery followed by adjuvant chemotherapy. However, in cases of advanced stages, large randomized controlled trials have indicated that neoadjuvant chemotherapy (NACT) * Sofia Lekka [email protected] 1
Department of Gynecologic Oncol
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