Hybrid surgical approach for advanced ovarian cancer: hybrid approach for robotic and minimal open abdominal cytoreduction technique

Objective: To assess the feasibility of a hybrid surgical approach combining robotic-assisted pelvic and laparotomic upper abdominal cytoreduction for advanced ovarian cancer. Methods: We retrospectively reviewed 20 patients with International Federation of Gynecology and Obstetrics stage III-IV ovarian cancer at the National Cancer Center, Korea, who underwent this hybrid approach between July 2023 and September 2024. Robotic surgery was performed for pelvic procedures, whereas upper abdominal cytoreduction was performed through a small laparotomy. Surgical outcomes included residual tumor status, operation time, estimated blood loss, complications, and postoperative recovery. Results: The median age was 53 years, with 75% of patients diagnosed with high-grade serous carcinoma. The median operation time was 342.5 minutes (range, 200.0-505.0), and the median blood loss was 300 mL (range, 5.0-1,500.0). No gross residual disease was achieved in 95% of patients. Intraoperative complications occurred in two patients (10.0%). The median hospital stay was 8 days (range, 6.0-14.0). Foley catheter removal and the first bowel gas passage occurred at a median of 3.5 and 3.0 postoperative days, respectively. Postoperative complications within 30 days included ileus (10.0%), pleural effusion (10.0%), bowel perforation (5.0%), thromboembolism (5.0%), and wound complications (5.0%). Adjuvant chemotherapy began at a median of 17 days postoperatively (range, 10.0-36.0), and 15% of patients were readmitted for ileus, wound complications, or bowel perforation. Conclusion: This hybrid approach demonstrates feasibility with acceptable morbidity in a selected cohort; however, the absence of a comparator group precludes conclusions regarding superiority over conventional approaches. Further prospective studies are required to validate these findings and evaluate long-term oncologic outcomes.