EP266/#300 Robotic-assisted laparoscopic ovarian cancer staging is associated with higher nodal yield in early-stage ovarian cancer: a national cancer database study

Objectives

Compare nodal yield by minimally-invasive surgical approach in early-stage (I-II) ovarian cancer.

Methods

The National Cancer Database (NCDB) was queried for patients with early stage (I-II) ovarian cancer between 2004 and 2017 who underwent minimally-invasive staging to compare adequate nodal yield by surgical approach.

Results

A total of 93,605 early-stage ovarian cancer cases were identified: 49,169 (52.5%) were stage I and 18,747 (20.0%) were stage II. Data was evaluable for 36,440 cases (38.9%). 12.4% (4,529) of lymph node assessments were performed robotically, 17.7% (6,434) were performed laparoscopically, and 69.9% (25,477) were performed via laparotomy. Conversion rates were 0.7% from robotic to open and 3.4% from laparoscopic to open. The most common histologic type was non-epithelial ovarian cancer (67.8%, 24,695). 57.2% of cases reviewed were privately insured, 43.1% received care at academic programs. The odds of sampling more than 10 lymph nodes with a laparoscopic approach was 76% that of open approach [OR 0.758 (95% CI 0.712–0.807), p<0.001] but similar between robotic and open [OR 1.062 (95% CI 0.991–1.138), p=0.091]. Robotic approach was associated with a higher median number of lymph nodes (median: robotic = 8, open = 7, laparoscopic = 4, all p<0.001). Open and robotic approaches were associated with higher LN yield (p<0.001), as was private insurance (p<0.001) figure 1. Nodal yield by surgery Robotic approach leads to a higher yield of pelvic lymph nodes (8) as compared to laparoscopic (4) and open (7).

Conclusions

Robotic-assisted laparoscopy is associated with the highest number of lymph nodes removed in early-stage ovarian cancer patients.