The impact of minimally invasive surgery in the treatment of ovarian cancer in young patients

Background: Surgery is the main pillar 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 behavior of ovarian cancer and its pattern of spread make it 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. 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 with invasive ovarian cancer from 2010 to 2019. Histological diagnosis was mandatory in all cases. All patients underwent surgery, which could be the initial treatment or after neoadjuvant chemotherapy. Depending on preoperative workup and surgical expertise, the surgical approach was either laparotomic or MIS. All data regarding the perioperative details, as well as prognostic factors, were compared depending on 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, length of surgery, and hospital stay were higher in the laparotomy group, and were statistically significant (p < 0.0001). Recurrences were present in 353 (30.85%) patients: 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: 169 (14.8%) after open surgery and 30 (2.6%) after MIS (p = 0.0026). Conclusions: Minimally invasive surgery does not seem to negatively impact the prognosis of young patients with ovarian cancer. Its use has been mainly for staging surgery in early-stage tumors, proving its safety with statistically significant differences. Nonetheless, these 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 these 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 a worse prognosis than laparotomy for ovarian cancer surgery.