Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine (Drs. Zhang, Paraghamian, Clark, and Ms. Grant).
Gynecologic Oncology Division, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine (Drs. Zhang, Paraghamian, Clark, and Ms. Grant).
J Minim Invasive Gynecol. 2021 Jun;28(6):1237-1243. doi: 10.1016/j.jmig.2020.11.015. Epub 2020 Nov 26.
Compare survival of patients with advanced epithelial ovarian cancer (EOC) undergoing interval debulking surgery (IDS) with either robot-assisted (R-IDS) or open (O-IDS) approach. Second, we assessed the impact of adjuvant and neoadjuvant chemotherapy (NACT) cycles as independent variables associated with survival in this patient population.
Retrospective cohort study.
Single tertiary care center.
Total of 93 patients diagnosed with advanced EOC who underwent NACT before primary debulking surgery after consultation with a gynecologic oncologist.
All patients underwent IDS after completion of NACT with either R-IDS or O-IDS between 2011 and 2018 at a single tertiary care center. Exclusion criteria included receiving fewer than 3 or more than 6 cycles of NACT or having concurrent diagnoses of other malignancies during the treatment period.
A total of 93 patients were identified (n = 43 R-IDS; n = 50 O-IDS). Median age (63.0 vs 66.2 years) did not differ between the 2 groups (p = .1). Of the total patients, 91% were optimally cytoreduced (57% R0 and 34% R1), and R0 rate was not influenced by surgical modality (52% O-IDS vs 63% R-IDS, p = .4). Progression-free survival (PFS) and overall survival (OS) did not differ between patients undergoing O-IDS and those undergoing R-IDS (PFS 15.4 vs 16.7 months, p = .7; OS 38.2 vs 35.6 months, p = .7). Cytoreduction to R0 improved both PFS and OS independent of surgical approach. Subgroup analysis showed that, specifically in patients undergoing R-IDS, receiving >6 total cycles of chemotherapy was independently associated with both decreased PFS (hazard ratio 3.85; 95% confidence interval, 1.52-9.73) and OS (hazard ratio 3.97; 95% confidence interval, 1.08-14.59). When analyzed separately, neither NACT nor adjuvant cycle numbers had any effect on survival.
In this retrospective study of patients with advanced EOC undergoing IDS after NACT, the use of robot-assisted surgery did not affect debulking success or oncologic survival indices. Receiving >6 total cycles of chemotherapy before IDS was associated with a decrease in both PFS and OS in patients undergoing R-IDS in this cohort and warrants further investigation.
比较接受间隔减瘤术（IDS）的晚期上皮性卵巢癌（EOC）患者的生存情况，这些患者接受的是机器人辅助（R-IDS）还是开放性（O-IDS）手术。其次，我们评估了辅助和新辅助化疗（NACT）周期作为与该患者人群生存相关的独立变量的影响。
回顾性队列研究。
单一体位的三级护理中心。
共 93 名经妇科肿瘤医生咨询后接受 NACT 治疗后进行原发性减瘤术的晚期 EOC 患者。
所有患者均在单一体位的三级护理中心接受 NACT 治疗后接受 IDS，手术方式为 R-IDS 或 O-IDS。排除标准包括接受 NACT 治疗的周期少于 3 个或多于 6 个，或在治疗期间同时患有其他恶性肿瘤。
共确定了 93 名患者（n=43 名 R-IDS；n=50 名 O-IDS）。两组患者的中位年龄（63.0 岁比 66.2 岁）无差异（p=0.1）。在所有患者中，91%的患者获得了最佳的肿瘤减灭术（57%的 R0 和 34%的 R1），而手术方式对 R0 率没有影响（52%的 O-IDS 与 63%的 R-IDS，p=0.4）。无进展生存期（PFS）和总生存期（OS）在接受 O-IDS 和 R-IDS 的患者之间没有差异（PFS 15.4 个月比 16.7 个月，p=0.7；OS 38.2 个月比 35.6 个月，p=0.7）。达到 R0 的肿瘤减灭术可改善 PFS 和 OS，而与手术方式无关。亚组分析显示，特别是在接受 R-IDS 的患者中，接受 >6 个周期的化疗与 PFS （风险比 3.85；95%置信区间，1.52-9.73）和 OS （风险比 3.97；95%置信区间，1.08-14.59）均降低有关。单独分析时，NACT 和辅助周期数均对生存无影响。
在这项接受 NACT 后行 IDS 的晚期 EOC 患者的回顾性研究中，机器人辅助手术的使用并未影响减瘤术的成功或肿瘤生存指标。在该队列中，接受 R-IDS 的患者接受 >6 个周期的化疗前与 PFS 和 OS 均降低有关，需要进一步研究。
