LAUSR

Study Objective To determine the effect of surgical approach on overall survival (OS) for women with advanced, epithelial ovarian cancer (EOC) following neoadjuvant chemotherapy (NACT) and to determine socio-demographic and medical factors associated with surgical approach. Design Retrospective cohort study. Setting National Cancer Database. Patients or Participants Women with stage IIIC/IV EOC treated with NACT within 90 days of diagnosis followed by cytoreductive surgery (CRS) from 2010-2016. Interventions Primary exposure was surgical approach (MIS versus open) and was evaluated by intention to treat. Our primary outcome was OS. Associations were examined using Chi-squared tests, Wilcoxon ranksum tests and multivariate logistic regression. Survival analysis was performed with Kaplan Meier methods and Cox proportional hazards models. Measurements and Main Results 8,085 women were identified; 6,713 (83%) underwent open CRS and 1,372 (17%) underwent MIS. The proportion undergoing MIS after NACT increased from 2% in 2010 to 11% in 2016, a nearly 6-fold increase. There was no difference in OS between women who underwent MIS and open CRS (median OS 36.5 vs 35.2 months, HR 0.94, 95%CI 0.86-1.04). Even after adjusting for demographicand clinical variables, including age, race, ethnicity, income, education, insurance, and comorbidity score, no difference in OS was observed (HR 0.95, 95%CI 0.86-1.04). Women of older age (OR 1.35, 95%CI 1.05-1.74) and Hispanic ethnicity (OR 1.46, 95%CI 1.14-1.88) had increased odds of receiving MIS, while low income ( Conclusion MIS has similar survival outcomes to open CRS among women with EOC who have undergone NACT.