Robotic approach for ovarian cancer: Perioperative and survival results and comparison with laparoscopy and laparotomy

Objective: Comparison of perioperative outcomes and survival of patients undergoing primary surgical treatment for epithelial ovarian cancer (EOC) by a robotic, laparoscopy, or laparotomy approach. Methods: Retrospective case-control analysis of 25 patients with EOC undergoing robotic surgical treatment between March 2004 and December 2008. Comparison was made with similar patients treated by laparoscopy and laparotomy and matched by age, body mass index (BMI), and type of procedures between January 1999 and December 2006. Results: The mean operating times were 314.8, 253.8 and 260.7 min for robotic, laparoscopy and laparotomy patients, respectively (p < 0.05); the mean blood loss was 164.0, 266.7, and 1307.0 ml, respectively (p = 0.001); the mean length of hospital stay was 4.2, 3.2, and 9.4 days, respectively (p = 0.001). The overall survival (OS) for robotics, laparoscopy and laparotomy patients was 67.1%, 75.6% and 66.0%, respectively (p = 0.08). Patients were subdivided and compared according to the extent of surgery by the type and number of major procedures. Type I and II debulking patients operated by robotics and laparoscopy had improved perioperative outcomes as compared to laparotomy. For patients undergoing a type III debulking, robotic outcomes were not improved over laparotomy. Conclusion: Laparoscopy and robotics are preferable to laparotomy for patients with ovarian cancer requiring primary tumor excision alone or with one additional major procedure. Laparotomy is preferable for patients requiring two or more additional major procedures. Survival is not affected by the type of surgical approach.