Mario M. Leitao, Jr, MD, FACOG, FACS
Refined surgical techniques continue to be explored and validated in the field of ovarian cancer to improve survival for these patients and, in some cases, preserve fertility, explains Mario M. Leitao, Jr, MD, FACOG, FACS.
In a retrospective single-center study, investigators reviewed experience with robotic interval cytoreduction (IRC) following neoadjuvant chemotherapy for patients with advanced ovarian cancer who were treated between 2011 and 2016 at the University of Rochester Medical Center. After a mean of 3.9 cycles of neoadjuvant chemotherapy, 29 patients underwent IRC. One case (3.3%) was converted to an open versus robotic procedure because of extensive tumor not amenable to robotic cytoreduction.
Results showed that the median overall survival was 39.7 months and median progression-free survival was 21.2 months. The investigators concluded that IRC following neoadjuvant chemotherapy is feasible and may be preferable to open interval cytoreductive surgery in select patients to decrease morbidity and length of hospital stay.
Leitao, attending surgeon, fellowship director in gynecologic oncology at Memorial Sloan Kettering Cancer Center, discusses how surgery retains its imperative role in ovarian cancer and sheds light on the challenges that still remain. He gave insight on this topic in an interview during the 2017 OncLive®
State of the Science Summit™ on Treatment Options in Ovarian Cancer.
OncLive®: You spoke on surgery tonight. How has this area of the landscape evolved?
Surgery is still a big part of ovarian cancer treatment, so the goal of surgeons is meant to reduce the amount of complications and make people recover quicker from surgery, with less complications and less time in hospital so they can get on to other treatment. In the past, standard surgery was very challenging, especially for ovarian cancer patients, because of the complexity of the surgeries.
Now, with the introduction of a robotic platform, we can do lots of surgeries and offer minimally invasive surgery, so that is what the robotic surgery has become. It is just a tool to do more laparoscopies for more patients and, therefore, decrease complications, improve their recovery, and get them onto the other therapies that they need. Then, we can use it for staging ovarian cancers where the cancer seems to be confined to the ovary and you just want to stage and see if it has spread to the lymph nodes. Without the robotics, it’s very difficult to do that.
Now, we’ve started to do more laparoscopic surgery, using the robotic approach for debulking of ovarian cancers. It’s a little limited in the upfront setting because of the amount of disease that you have to deal with. With relatively lower-volume disease, you can absolutely use the robotic approach and get folks home the same day of the surgery.
For the recurrent setting, it’s been helpful—especially with isolated recurrences—and being able to remove that. We can also do multi-organ resection with the robotic method now. We routinely consider these patients eligible to go home the same day of surgery—back to their family and their home. They receive their therapies quicker and deal with a lot less complications compared with traditional open surgery.