title: Laparoscopy Compared With Laparotomy for Debulking Ovarian Cancer After Neoadjuvant Chemotherapy.
abstract: To compare 3-year survival, length of hospitalization, perioperative mortality, risk of readmission, and residual disease associated with laparoscopic and laparotomic interval debulking surgery among women with epithelial ovarian cancer.
  
  
  
  We used the National Cancer Database to identify a cohort of patients diagnosed with stage IIIC and IV epithelial ovarian cancer between 2010 and 2012 who underwent neoadjuvant chemotherapy and interval debulking surgery. We compared 3-year overall survival, duration of postoperative hospitalization, 90-day postoperative mortality, and residual disease status between women who underwent interval debulking by laparoscopy and by laparotomy. We used the Kaplan-Meier method and Cox regression models in survival analyses. At a significance of .05, this study had 80% power to detect an 8% difference in 3-year survival. The main analysis was intention to treat.
  
  
  
  We identified 3,071 women meeting inclusion criteria, of whom 450 (15%) underwent surgery initiated laparoscopically. There was no difference in 3-year survival between patients undergoing laparoscopy [47.5%; 95% confidence interval (CI) 41.4-53.5] and laparotomy (52.6%; 95% CI 50.3-55.0; P=.12). Survival did not differ after adjustment for demographic characteristics, facility type, presence of comorbidities, and stage (adjusted hazard ratio, 1.09; 95% CI 0.93-1.28; P=.26). Postoperative hospitalization was slightly shorter in the laparoscopy group (median 4 compared with 5 days, P<.001). Frequency of readmission (5.3% compared with 3.7%; P=.26), death within 90 days of surgery (2.8% compared with 2.9%, P=.93), and suboptimal debulking (20.6% compared with 22.6%, P=.29) did not differ between patients undergoing laparoscopy and laparotomy.
  
  
  
  Ovarian cancer patients selected for laparoscopic interval debulking surgery after neoadjuvant chemotherapy have 3-year survival rates similar to women who undergo interval debulking by laparotomy. Laparoscopy is associated with a modestly shorter postoperative hospitalization, whereas readmission rates and risk of perioperative death are similar for the surgeries.
authors.affiliation: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alexander
authors.initials: A
authors.lastname: Melamed
authors.forename: Roni
authors.initials: R
authors.lastname: Nitecki
authors.forename: David M
authors.initials: DM
authors.lastname: Boruta
authors.forename: Marcela G
authors.initials: MG
authors.lastname: Del Carmen
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Clark
authors.forename: Whitfield B
authors.initials: WB
authors.lastname: Growdon
authors.forename: Annekathryn
authors.initials: A
authors.lastname: Goodman
authors.forename: John O
authors.initials: JO
authors.lastname: Schorge
authors.forename: J Alejandro
authors.initials: JA
authors.lastname: Rauh-Hain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018284:Cystadenocarcinoma, Serous / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D065426:Cytoreduction Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology