The Short And Long-term Outcomes Of The Laparoscopy And Laparotomy Debulking Surgery For Advanced Epithelial Ovarian Cancer Patients

Background:Ovarian cancer was one of the most lethal gynecological cancer,which was hard to detect at early stages because these patients were lack of typical symptoms and early specific examinations.Most patients were diagnosed as epithelial ovarian cancer at advanced stages.The therapies for ovarian cancer patients usually were comprised of debulking surgery,adjuvant chemotherapy,some with immunotherapy or targeted drugs.With the development of clinical medicine,though the survival results for the ovarian cancer patients were encouraging,the majority of patients would undergo recurrence within 3 years and finally died[1,2].The mainstay of treatment was laparotomy primary debulking surgery followed by adjuvant chemotherapy,which was aimed at the optimal surgery.However,patients with too heavy tumor load or terrible conditions were unbearable to anaesthesia or the stress induced by surgery,and it’s also risky for doctors to achieve optimal debulking surgery.As a result,some patients were suggested to neoadjuvant chemotherapy followed by interval debulking surgery,former prospective researches proved that these two types of treatment didn’t affect the long-term outcomes[3,4].But neoadjuvant chemotherapy may increase the risk of platinum resistance compared with primary surgery[5].The complications of laparotomy included high risk of surgery,long recovering time.Researches had showed feasibility of laparoscopy to evaluate the tumor burden and manage the early-stage ovarian cancer patients.But it appeared difficult for laparoscopy to eradicate all the disease as tumor may spread to upper body or the whole abdomen.Nowadays,some researches supported that laparoscopic debulking surgery could be used for the advanced ovarian cancer patients by strict selections[6].However,the debate about laparoscopic or laparotomy debulking surgery,primary or interval debulking surgery was going on[7-9].Here we want to investigate the post-operative effects and survival outcomes of laparoscopic and interval debulking surgery for those who received the laparoscopic and laparotomy primary or interval debulking surgery,by comparing the variances of the surgery risk,short and long-term outcomes.Method:We reviewed the data of those who were diagnosed as advanced epithelial ovarian cancer patients from Jan 1^st 2009 to Dec 31^st 2017 in the Southwest hospital,including 210 patients of laparoscopy surgery,96 by primary debulking surgery and 114 by interval debulking surgery,27patients of open debulking surgery,22 by primary debulking surgery and 5 by interval debulking surgery,to compare the surgery risk,short and long-term effects.We used propensity score matching by SPSS26 to balance the differences between laparoscopy and open debulking surgery before calculation.Results:1.After 1:4 propensity score matching by SPSS26,the differences of baseline characteristics between the laparoscopy and laparotomy group were well balanced.laparoscopy vs laparotomy group 1)surgery risk:surgery time[（3.6±0.9）vs（4.9±1.8）h],blood volume[（361.0±306.1）vs（1493.2±985.4）ml],and transfusion during surgery（31.7%vs95.5%）in the laparoscopy group were better（P<0.05）;2)short-term results:the time of postoperative exhaust[（2.4±0.7）vs（3.8±1.5）d],postoperative complications within 30days（25.0%vs 54.4%）,the length of hospitalization[（13.8±4.0）vs（17.7±5.5）d]and time to chemotherapy[（6.6±3.2）vs（9.3±4.7）d]were shorter in the laparoscopy group（P<0.05）3)long-term results:the differences of overall and progression free survival between the two groups were insignificant（56.0 vs 49.0 months,P=0.736;23.0 vs 19.0 months,P=0.343）;2.Primary vs interval debulking surgery:1)longer surgery time[（3.8±1.0）vs（3.4±1.0）h]and more transfusion（33.3%vs 16.7%）during surgery in the laparoscopy primary debulking surgery（PDS）group（t=3.317,χ²=7.873,P=0.001,P=0.005）,longer surgery time[（5.2±1.7）vs（3.4±0.6）h]in the laparotomy PDS group（t=2.290 P=0.031）,but similar results of other observations about surgery risk,short and long-term results were shown similar（P>0.05）.There is no significant difference between systemic lymphadenectomy and intraperitoneal chemotherapy cycles on the long-term outcomes within the laparoscopy group（P>0.05）.Conclusion:Laparoscopy and interval debulking surgery could decrease the surgery risk including lower volume of blood lose,shorter surgery duration,but the survival results were inferior when comparing with the laparotomy and primary debulking surgery.Therefore,laparoscopy and interval debulking surgery could be a feasible option for some carefully selected advanced epithelial ovarian cancer patients.Systemic pelvic or paraaortic lymphadenectomy and intraperitoneal chemotherapy didn’t affect patients’overall survival and progression free survival in the laparoscopy group.