Is Same-Day Discharge Following Minimally Invasive Interval Debulking Surgery for Advanced Ovarian Cancer a Safe Alternative to Admission?

A retrospective cohort study of more than 4000 patients with stage III or IV epithelial ovarian cancer (EOC) suggests that same-day discharge (SDD) following minimally invasive interval debulking surgery (IDS) is not associated with increased readmission or postoperative mortality, though selection bias and low event rates limit definitive conclusions. This study was presented at the Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer.

Minimally invasive IDS is an increasingly utilized treatment approach in advanced EOC, offering potential benefits such as reduced morbidity and faster recovery. One proposed advantage of minimally invasive surgery (MIS) is the possibility of SDD, a strategy widely adopted in ovarian cancer staging surgery. However, limited data exist on the safety of SDD following IDS.

This retrospective cohort study included patients diagnosed with stage III or IV EOC between 2010 and 2021 who received care at Commission on Cancer-accredited cancer programs in the United States (n = 4007). Only patients who underwent neoadjuvant chemotherapy followed by minimally invasive IDS were included, while those who had conversions to laparotomy or an unknown surgical approach were excluded. Associations between patient, surgical, and hospital characteristics and SDD were assessed, and postoperative outcomes, including readmission and 90-day mortality, were analyzed using multivariable logistic regression, adjusting for key confounders.

Researchers found that 11.5% (n = 459) of the 4007 patients with stage III or IV EOC had SDD. This patient population were more likely to have simpler cytoreductive procedures compared with those admitted postoperatively (87.1% vs 82.6%, P = .01), achieve no residual disease (65.2% vs 51.8%, P < .001), and be diagnosed after 2018 (50.8% vs 44.0%, P = .006). No significant differences were observed in readmission rates (2.0% for SDD vs 2.5% for admission; odds ratio [OR] = 1.0; 95% CI, 0.5-1.9, P = .99) or 90-day postoperative mortality (1.3% for SDD vs 1.7% for admission; OR = 1.0; 95% CI, 0.4-2.4, P = .95).

Additionally, SDD was more common in patients residing in the Northeast or West census regions (47.3% vs 38.2%, P = .991) and in those from higher-income zip codes (43.6% vs 34.9%, P = .001). Age, race, ethnicity, comorbidity burden (Charlson score), and histology were not significantly associated with SDD. The length of hospital stay for admitted patients averaged 3.9 days (SD 5.7). SDD was not associated with an increased risk of readmission or 90-day mortality compared with admission, suggesting comparable short-term safety.

Limitations of the study include the small sample size of the SDD cohort, the low number of adverse events, and the potential for selection bias, as patients undergoing SDD may have had more favorable baseline characteristics.

“A small proportion of patients undergoing minimally invasive IDS for advanced EOC undergo SDD, although our data suggest that rates of SDD have increased over the last several years,” the authors concluded. “SDD is not associated with readmission or postoperative mortality and appears to be a safe alternative to admission.”

Reference
Tewari S. Same-day discharge after minimally invasive interval debulking surgery in advanced-stage ovarian cancer. Paper presented at: Society of Gynecologic Oncology 2025 Annual Meeting on Women’s Cancer; March 14-17, 2025; Seattle, WA. Accessed March 17, 2025. https://www.sgo.org/events/annual-meeting/.