Impact of laparoscopic surgical algorithm to triage timing of tumor reductive surgery on overall survival in newly diagnosed advanced ovarian cancer (548)

Abstract

<b>Objectives:</b> To estimate the effects of implementing a laparoscopic scoring algorithm to triage timing of tumor reductive surgery (TRS) in patients with newly diagnosed advanced-stage ovarian cancer on overall survival. <b>Methods:</b> In April 2013, we initiated a prospective quality improvement project utilizing laparoscopic scoring assessment to determine primary resectability in patients with newly diagnosed advanced- stage ovarian cancer in order to improve complete gross resection rates (R0). Current data were analyzed through March 2021. Patients who were medically inoperable or had distant metastatic disease did not undergo laparoscopic assessment and received neoadjuvant chemotherapy (NACT). A validated scoring method was used, and patients with predictive index value (PIV) > 10 received NACT, and those with PIV < 10 were offered primary TRS (algorithm updated from PIV <8 on March 1, 2018). Univariate and multivariate analysis was performed for effects of overall survival (OS). <b>Results:</b> A total of 1,124 patients were included in our analysis; the median follow-up was 28 months (1-96 months). Three hundred forty-five patients (31%) underwent laparoscopic scoring assessment, of which 206 patients (59%) had PIV <10, 112 patients (32%) had PIV > 10, 10 patients (3%) were unscorable, and 17 patients (5%) had an outside laparoscopic assessment with score unknown. Six hundred sixty-four (59%) patients were triaged directly to NACT without laparoscopic assessment. Patients triaged to primary TRS had a lower median CA-125 (404 vs 647 U/mL, p<0.001) and lower median platelet count at diagnosis (312 vs 365, p<0.001) compared to those triaged to NACT by laparoscopy. There was no difference in complete gross resection rates (R0) between those patients triaged to primary TRS versus NACT (84% vs 75%, p=0.32); however, 13% of patients triaged to NACT (p<0.001) were not candidates for interval TRS due to either stable disease (4%) or death (6%). Patients who underwent primary TRS had a significantly longer OS (85.4 months) compared to those who underwent NACT following laparoscopy (36.6 months) or were triaged to NACT and not candidates for laparoscopic assessment (38.5 months, p<0.001). Age (p<0.001), advanced stage (p<0.001), Charlson comorbidity index (p<0.001), platelet count at diagnosis (p=0.001), germline <i>BRCA</i> mutation status (p<0.001), and complete gross resection at TRS (<0.001) were factors significantly associated with OS in our patient population. <b>Conclusions:</b> Implementation of laparoscopic scoring triage in patients with newly diagnosed advanced-stage ovarian patients resulted in high complete gross resection rates at TRS and appropriately triaged select patients to primary TRS who had significantly longer OS. Laparoscopic scoring assessment is a valuable tool to incorporate into surgical practice in advanced ovarian cancer.