MIRRORS: a prospective cohort study assessing the feasibility of robotic interval debulking surgery for advanced-stage ovarian cancer.

Uwins, Christina; Assalaarachchi, Hasanthi; Bennett, Kate; Read, James; Tailor, Anil; Crawshaw, James; Chatterjee, Jayanta; Ellis, Patricia; Skene, Simon S.; Michael, Agnieszka; Butler-Manuel, Simon

Abstract

The object of this research was to establish the feasibility and safety of robotic interval debulking surgery following the MIRRORS protocol (robot-assisted laparoscopic assessment prior to robotic or open surgery) in women with advanced-stage ovarian cancer. MIRRORS is the first of three planned trials: MIRRORS, MIRRORS-RCT (pilot), and MIRRORS-RCT. The participants were patients with stage IIIc-IVb epithelial ovarian cancer undergoing neo-adjuvant chemotherapy, suitable for interval debulking surgery with a pelvic mass ≤8 cm. The intervention was robot-assisted laparoscopic assessment prior to robotic or open interval debulking surgery (MIRRORS protocol). The primary outcome was feasibility of recruitment, and the secondary outcomes were quality of life (EORTC QLQC30/OV28, HADS questionnaires), pain, surgical complications, complete cytoreduction rate (%), conversion to open surgery (%), and overall and progression-free survival at 1 year. Overall, 95.8% (23/24) of patients who were eligible were recruited. Median age was 68 years (range 53–83). All patients had high grade serous histology and were BRCA negative. In total, 56.5% were stage IV, 43.5% were stage III, 87.0% had a partial response, while 13.0% had stable disease by RECIST 1.1. Median peritoneal cancer index was 24 (range 6–38). Following MIRRORS protocol, 87.0% (20/23) underwent robotic interval debulking surgery, and 13.0% (3/23) had open surgery. All patients achieved R<1 (robotic R0=47.4%, open R0=0%). No patients had conversion to open. Median estimated blood loss was 50 mL for robotic (range 20–500 mL), 2026 mL for open (range 2000–2800 mL) (p=0.001). Median intensive care length of stay was 0 days for robotic (range 0–8) and 3 days (range 3–13) for MIRRORS Open (p=0.012). The median length of stay was 1.5 days for robotic (range 1–17), 6 days for open (range 5–41) (p=0.012). The time to chemotherapy was as follows 18.5 days for robotic (range 13–28), 25 days for open (range 22–28) (p=0.139). Robotic interval debulking surgery appears safe and feasible for experienced robotic surgeons in patients with a pelvic mass ≤8 cm. A randomized controlled trial (MIRRORS-RCT) will determine whether MIRRORS protocol has non-inferior survival (overall and progression-free) compared with open interval debulking surgery.

Citation

UWINS, C., ASSALAARACHCHI, H., BENNETT, K., READ, J., TAILOR, A., CRAWSHAW, J., CHATTERJEE, J., ELLIS, P., SKENE, S.S., MICHAEL, A. and BUTLER-MANUEL, S. 2024. MIRRORS: a prospective cohort study assessing the feasibility of robotic interval debulking surgery for advanced-stage ovarian cancer. International journal of gynecological cancer [online], 34(6), pages 886-897. Available from: https://doi.org/10.1136/ijgc-2024-005265

• Journal Article Type: Article
• Acceptance Date: Mar 12, 2024
• Online Publication Date: Apr 1, 2024
• Publication Date: Jun 30, 2024
• Deposit Date: Jun 11, 2024
• Publicly Available Date: Jun 11, 2024
• Journal: International journal of gynecological cancer
• Print ISSN: 1048-891X
• Electronic ISSN: 1525-1438
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 34
• Issue: 6
• Pages: 886-897
• DOI: https://doi.org/10.1136/ijgc-2024-005265
• Keywords: Robot-assisted surgery; Ovarian cancer; Robotic interval debulking surgeries; Randomized controlled trials
• Public URL: https://rgu-repository.worktribe.com/output/2368434
• Additional Information: This article has been published with separate supporting information. This supporting information has been incorporated into a single file on this repository and can be found at the end of the file associated with this output.