Accuracy of Robotic Cytoreduction Estimates for Ovarian Epithelial Malignancies [33E

Abstract

INTRODUCTION: Robotic surgery has become the standard for surgical treatment of early cervical and endometrial carcinomas. The purpose was to determine if robotic cytoreduction estimates are accurate. METHODS: All patients with stage IIIc or IV ovarian carcinoma who presented for second opinions after primary surgery was performed robotically were offered a laparotomy and attempt at complete cytoreduction within 6 weeks of initial surgery. RESULTS: Nineteen patients met the inclusion criteria. The median age was 51 years (mean 51.4, 95% CI 47.3-55.5). Thirteen patients were said to have no residual disease while 6 patients were declared optimally cytoreduced after robotic debulking. Significant differences in cytoreduction were found in 15 of 19 patients at time of laparotomy (P=0.028). All 13 (complete cytoreduction) patients were found to have residual disease with 9 of them having disease greater than >1 cm and four of them with disease < 1 cm. Of the six patients optimally robotically debulked, four had disease < 1 cm and two had gross disease >1 cm. In all 19, complete cytoreduction was attained. Fifteen patients had residual disease after robotic debulking in the upper abdomen (diaphragm, liver, infragastric omentum), thirteen had residual disease on bowel mesentery or surface, and nine had residual disease in the pelvis. The median hospital stay was 3 days (mean 3.53, 95% CI 3.02-4.04). CONCLUSION: It appears to be very difficult to accurately access the level of cytoreduction at time of robotic surgery. Open cytoreduction can achieve no visible or palpable residual disease after a robotic surgery.