Review Article
Minimally Invasive Surgical Staging in Early-stage Ovarian Carcinoma: A Systematic Review and Meta-analysis

https://doi.org/10.1016/j.jmig.2017.02.013Get rights and content

Abstract

Few studies investigated the efficacy and safety of minimally invasive surgery for the treatment of early-stage epithelial ovarian cancer (eEOC). In this context, we aimed to review the current evidence comparing laparoscopy and the laparotomic approach for staging procedures in eEOC. This systematic review was registered in the International Prospective Register of Systematic Reviews. Overall, 3065 patients were included: 1450 undergoing laparoscopy and 1615 undergoing laparotomic staging. Patients undergoing laparoscopy experienced a longer (but not statistically significant) operative time (weighted mean difference [WMD] = 28.3 minutes; 95% confidence interval [CI], −2.59 to 59.2), a lower estimated blood loss (WMD = −156.5 mL; 95% CI, −216.4 to −96.5), a shorter length of hospital stay (WMD = −3.7 days; 95% CI, −5.2 to −2.1), and a lower postoperative complication rate (odds ratio [OR] = 0.48; 95% CI, 0.29–0.81) than patients undergoing laparotomy. The upstaging (OR = 0.81; 95% CI, 0.55–1.20) and cyst rupture (OR = 1.32; 95% CI, 0.52–3.38) rates were similar between groups. Laparoscopic staging is associated with a shorter time to chemotherapy than laparotomic procedures (WMD = −5.16 days; 95% CI, −8.68 to −1.64). Survival outcomes were not influenced by the route of surgery. Pooled data suggested that the minimally invasive surgical approach is equivalent to laparotomy for the treatment of eEOC and may be superior in terms of perioperative outcomes. However, because of the low level of evidence of the included studies, further randomized trials are warranted.

Section snippets

Methods

The study search was designed to include population criteria, surgical interventions, and outcomes. Our systematic review was modeled according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement [7], and it was registered in the International Prospective Register of Systematic Reviews (available at http://www.crd.york.ac.uk/PROSPERO; CRD42016050582). As such, PubMed, Scopus, Web of Science, and EMBASE databases and ClinicalTrials.gov (www.clincaltrials.gov) were

Evidence Acquisition

Using the search criteria, 209 citations were initially identified. After applying the exclusion criteria, 11 publications remained 12, 13, 14, 15, 16, 17, 18, 19, 20, 21. Of the 11 comparative studies that met the inclusion criteria for this review, all were retrospective. Details of the process of evidence acquisition are displayed in Supplemental Figure 1. The included studies and their main characteristics are listed in Table 1. Overall, the 11 studies included 3065 patients. Specifically,

Discussion

This review article compares the current evidence on comparative studies evaluating MIS versus laparoscopy in the management of eEOC. Eleven retrospective studies including a total of 3065 patients show that MIS is associated with statistically better operative outcomes in comparison with open surgery. In fact, although the operative time is slightly (but not statistically significant) longer, patients undergoing laparoscopy experienced a lower estimated blood loss and a shorter length of

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    Dr. Raspagliesi declared previous personal fees for serving on the board from Roche and PharmaMar. Dr. Lorusso declared previous grants and personal fees for board from PharmaMar and previous personal fees for board from Roche and AstraZeneca.

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