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Master of Public Health

Survival Outcomes for Robotic-Assisted Laparoscopy Versus Traditional Laparoscopy in Clinical Stage I Epithelial Ovarian Cancer

AUTHORS

Facer B , Wang F , Grijalva CG , Alvarez RD , Shu XO , . American journal of obstetrics and gynecology. 2019 11 9; ().

ABSTRACT

BACKGROUND: The Food and Drug Administration recently called for studies addressing long-term survival after robotic-assisted laparoscopy in oncologic settings. Long-term clinical outcomes of robotic-assisted laparoscopy among ovarian cancer patients are understudied.

OBJECTIVE(S): To investigate the long-term mortality of robotic-assisted laparoscopy compared to traditional laparoscopy for clinical stage I epithelial ovarian cancer.

STUDY DESIGN: Using data from the National Cancer Database, we identified a total of 1,901 patients who received minimally invasive surgery (i.e., robotic-assisted laparoscopy or traditional laparoscopy) for clinical stage I epithelial ovarian cancer between 2010 and 2014. Multivariable logistic or linear regression analyses were conducted to evaluate the short-term outcomes, including conversion-to-open surgery, number of lymph nodes examined, length of hospitalization, unplanned 30-day readmission and 30- and 90-day mortality. Multivariable Cox proportional hazards models were used to derive adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for 1-, 3- and 5-year total mortality associated with surgical approaches. Covariates adjusted for included age, tumor size and upstaging, number of lymph nodes evaluated, time from diagnosis to surgery, length of hospitalization, histologic subtype, insurance status, region, distance to care, surgical procedure type, and hospital experience with these procedures.

RESULTS: Compared to traditional laparoscopy, robotic-assisted laparoscopy was less likely to result in conversion-to-open surgery (conversion rate: 7.2% vs 17.9%, P<0.001; adjusted odds ratio (OR): 0.49, 95% CI: 0.33-0.73). In multivariable analyses, there were no significant differences in survival between robotic-assisted laparoscopy and traditional laparoscopy treated patients. Compared with traditional laparoscopy, the adjusted HRs for 1-, 3- and 5-year mortality were: 0.97 (95% CI: 0.43-2.18), 0.68 (95% CI: 0.43-1.08) and 0.78 (95% CI: 0.53-1.16), respectively.

CONCLUSION(S): Robotic-assisted laparoscopy had comparable overall mortality in comparison to traditional laparoscopy when treating clinical stage I epithelial ovarian cancer.

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