Outcomes of robot-assisted interval debulking surgery in older women with advanced ovarian cancer unfit for laparotomy: A real-world study.

Abstract

e17600 Background: Older women with advanced epithelial ovarian cancer frequently have comorbidities and frailty that limit suitability for open interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). Evidence on robot-assisted IDS (RA-IDS) in this population remains limited. We compared perioperative and early oncologic outcomes of RA-IDS offered to patients deemed unfit for open cytoreduction with contemporaneous open IDS in older women. Methods: We conducted a single-centre retrospective real-world study of women aged 65 years or older who underwent IDS following NACT between January 2025 and October 2025. RA-IDS was offered only to patients considered unsuitable for open IDS by multidisciplinary assessment. Perioperative and early oncologic outcomes were compared with women aged 65 years or older undergoing open IDS during the same period. Analyses were unadjusted. Results: RA-IDS was offered to 15 women deemed unfit for open cytoreductive surgery; 10 (66.7%) accepted and underwent RA-IDS. During the same period, 16 women aged 65 years or older underwent open IDS. Patients treated with RA-IDS were older (median age 72 years [IQR 68–76] vs 68 years [65–72]) and had a higher comorbidity burden (median Charlson Comorbidity Index 7 [6–10] vs 5 [4–7]). The majority had FIGO stage IIIC disease (80% vs 87.5%). Median Peritoneal Carcinomatosis Index was comparable (16 [11–26] vs 18 [11–28]). BRCA mutation or homologous recombination deficiency was present in 40% of RA-IDS and 50% of open IDS patients. Among patients selected for RA-IDS, reasons for unsuitability included ongoing antiplatelet or anticoagulant therapy for recent cardiac or thromboembolic disease (60%), frailty with poor nutritional status (20%), and severe renal disease (20%). Conversion to laparotomy occurred in 1 patient (10%) due to extensive diaphragmatic disease. Major postoperative complications (Clavien-Dindo grade ≥3) occurred in 10% of RA-IDS patients compared with 69% of open IDS patients. There was no 30-day mortality. Complete gross resection was achieved in 80% of RA-IDS and 81% of open IDS cases. Median length of hospital stay was shorter following RA-IDS (3 days [2–5] vs 8 days [6–11]), with lower estimated blood loss (60 mL [50–100] vs 300 mL [100–500]) and earlier initiation of adjuvant chemotherapy (23 days [21–30] vs 27 days [27–40]). Six-month progression-free survival was comparable between groups (80% vs 81%). Conclusions: In a real-world cohort of older ovarian cancer patients with higher comorbidity burden deemed unsuitable for open IDS, RA-IDS had lower major morbidity, faster recovery, and preserved early oncologic outcomes. These findings support prospective evaluation of RA-IDS as a risk-mitigation strategy to enable cytoreductive surgery in selected older and frail ovarian cancer patients otherwise excluded from surgical management.