Impact of Surgical Approach for the Treatment of Ovarian Cancer in Young Patients

• DOI: 10.20944/preprints202505.0173.v1
• Publication Date: 2025-05-08T03:26:07Z
• Authors: Marta Heras; Mikel Gorostidi; Octavio Arencibia; Lucas Minig; Lola Marti; Myriam Gracia; Arantxa Lekuona; Isabel Niguez; Blanca Gil-Ibañez; Berta Díaz-Feijóo; Ana Gómez; Ana Lara; Rosa Álvarez; Virginia Corraliza; Jose C Vilches; Maria de Marino; Pluvio Coronado; Silvia Duch; Emilio Bayon; Iria Aparicio; Raquel del Moral; Gemma Mancebo; Iñaki Lete; Violeta Tetilla; Ignacio Zapardiel...

Introduction: Surgery is the main pilar for the treatment of ovarian cancer patients. The improvement of minimally invasive surgery (MIS) has led to its application to a greater number of processes. However, MIS for ovarian cancer is still under debate, since the behaviour of ovarian cancer and its pattern of spread make difficult to assure a proper surgery with this approach. Our aim was to evaluate the advantages of MIS in the management of ovarian cancer among young patients.

Materials and Methods: A retrospective study was conducted with the participation of 55 Spanish hospitals. We included all patients aged between 18 and 45 years old who were diagnosed of invasive ovarian cancer from 2010 to 2019. Histological diagnosis was mandatory in all cases. All patients underwent surgery, that could be the initial treatment or after neoadjuvant chemotherapy. Depending on preoperative workup and surgical expertise, surgical approach was either laparotomic or MIS. All data regarding the perioperative details as well as prognostic factors were compared in regards to the type of surgical approach.

Results: A total of 1144 patients were collected, among them, 867 (75.8%) underwent laparotomy and 277 (24.2%) MIS. Epithelial tumors were diagnosed in 992 (86.7%) patients and non epithelial cancers in 152 (13.3%). Complications such as blood loss, lenght of surgery and hospital stay were higher in the laparotomy group, and was statistically significant (p< 0.0001). Recurrences were present in 353 (30.85%) patients, wich were 302 (26.4%) in the open surgery group and 51 (4.45%) in the MIS (p < 0.0001). Deaths were reported in 199 (17.4%) patients, that were 169 (14.8%) after open surgery and 30 (2.6%) after MIS (p = 0.0026).

Conclusion: Minimally invasive surgery does not seem to impact negatively in the prognosis of young patients with ovarian cancer. Its use has been mainly for staging surgery in early- stage tumors, proving its safety. Progression Free Survival (PFS) and Overall Survival (OS) after MIS have shown its superiority over open surgery, with statistically significant differences. Nonetheless, those results are highly influenced by the predominance of early- stage and low burden disease tumors in the MIS group.Moreover, there are confounding variables that seem to influence in those results, such as age, tumor size, FIGO stage and histology, which are important to consider in order to choose the best surgical approach. When the selection of patients is adequate, MIS does not entail worse prognosis than laparotomy, for ovarian cancer surgery.