Adoption of minimally invasive surgery after neoadjuvant chemotherapy in women with metastatic uterine cancer (462)

Abstract

Objectives: The utilization of neoadjuvant chemotherapy (NACT) for advanced-stage uterine cancer is increasing. However, the relationship between NACT administration and the type of surgical approach used for interval debulking surgery (IDS) remains unknown. We analyzed the use and outcomes of open versus minimally invasive surgery (MIS) for women with stage IV uterine cancer who received NACT and underwent IDS. Methods: The National Cancer Database was used to identify women with stage IV uterine cancer diagnosed from 2010 to 2017 and treated with NACT. Among women who underwent IDS, overall survival (OS) was compared between those who underwent laparotomy versus a minimally invasive approach. To account for imbalances in confound- ers, a propensity score analysis using inverse probability of treatment weighting (IPTW) was performed. Cox proportional hazards models to compare all-cause mortality between the groups were examined. Results: A total of 1,618 women with stage IV uterine cancer who received NACT were identified. Overall, minimally invasive IDS was performed in 31.1% of the cohort. MIS use increased from 16.2% in 2010 to 40.4% in 2017 (p<0.001). More recent years of diagnosis and performance of surgery at a comprehensive cancer center or integrated network cancer center were associated with increased use of MIS (p<0.05). Women with serous and clear cell tumors and carcinosarcomas (compared to endometrioid tumors), as well as Medicaid coverage (compared to commercial insurance), were less likely to undergo a minimally invasive surgical approach (p<0.05). The median OS was 28 months (95% CI: 23.7-30.7) and 24.3 months (95% CI: 22.3-26.1) for MIS and laparotomy, respectively. After propensity score balancing, there was no association between the use of MIS and overall survival (HR: 0.90, 95% CI: 0.71-1.14). Conclusions: Among women with stage IV uterine cancer treated with neoadjuvant chemotherapy, the performance of minimally invasive debulking surgery is common and increasing. Compared to laparotomy, MIS does not appear to negatively impact survival. Objectives: The utilization of neoadjuvant chemotherapy (NACT) for advanced-stage uterine cancer is increasing. However, the relationship between NACT administration and the type of surgical approach used for interval debulking surgery (IDS) remains unknown. We analyzed the use and outcomes of open versus minimally invasive surgery (MIS) for women with stage IV uterine cancer who received NACT and underwent IDS. Methods: The National Cancer Database was used to identify women with stage IV uterine cancer diagnosed from 2010 to 2017 and treated with NACT. Among women who underwent IDS, overall survival (OS) was compared between those who underwent laparotomy versus a minimally invasive approach. To account for imbalances in confound- ers, a propensity score analysis using inverse probability of treatment weighting (IPTW) was performed. Cox proportional hazards models to compare all-cause mortality between the groups were examined. Results: A total of 1,618 women with stage IV uterine cancer who received NACT were identified. Overall, minimally invasive IDS was performed in 31.1% of the cohort. MIS use increased from 16.2% in 2010 to 40.4% in 2017 (p<0.001). More recent years of diagnosis and performance of surgery at a comprehensive cancer center or integrated network cancer center were associated with increased use of MIS (p<0.05). Women with serous and clear cell tumors and carcinosarcomas (compared to endometrioid tumors), as well as Medicaid coverage (compared to commercial insurance), were less likely to undergo a minimally invasive surgical approach (p<0.05). The median OS was 28 months (95% CI: 23.7-30.7) and 24.3 months (95% CI: 22.3-26.1) for MIS and laparotomy, respectively. After propensity score balancing, there was no association between the use of MIS and overall survival (HR: 0.90, 95% CI: 0.71-1.14). Conclusions: Among women with stage IV uterine cancer treated with neoadjuvant chemotherapy, the performance of minimally invasive debulking surgery is common and increasing. Compared to laparotomy, MIS does not appear to negatively impact survival.