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Staging laparoscopy for the management of early-stage ovarian cancer: a metaanalysis

  • Hyun Jong Park
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Dong Wook Kim
    Affiliations
    Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Ga Won Yim
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Eun Ji Nam
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Sunghoon Kim
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Young Tae Kim
    Correspondence
    Reprints: Young Tae Kim, MD, PhD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, 250 Seongsanno, 134 Shinchon-dong, Seodaemun-gu, 120-752 Seoul, Republic of Korea.
    Affiliations
    Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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Published:April 12, 2013DOI:https://doi.org/10.1016/j.ajog.2013.04.013

      Objective

      We sought to perform a quantitative analysis on operative outcomes of laparoscopic staging surgery in patients with presumed early-stage ovarian cancer using a metaanalysis.

      Study Design

      Electronic searches for studies of laparoscopic staging surgery in patients with ovarian cancer were performed within 3 electronic databases (Medline, Embase, and the Cochrane Library) using the key words "ovarian cancer,” “early stage,” "laparoscopy,” "staging surgery,” “staging laparoscopy,” and “recurrence.” Two authors independently screened articles, and those meeting the defined inclusion/exclusion criteria were included in the metaanalysis.

      Results

      We identified 11 observational studies. The combined results of 3 retrospective studies showed that the estimated blood loss in laparoscopy was significantly lower than that for laparotomy (P < .001). The overall upstaging rate after laparoscopic surgery was 22.6% (95% confidence interval [CI], 18.1–27.9%) without significant heterogeneity among all study results. The overall incidence of conversion from laparoscopy to laparotomy was 3.7% (95% CI, 2.0–6.9%). The overall rate of recurrence in studies with a median follow-up period of ≥19 months was 9.9% (95% CI, 6.7–14.4%).

      Conclusion

      Through our quantitative analysis, we concluded that the operative outcomes of a laparoscopic approach in patients with early-stage ovarian cancer could be compatible with those of laparotomy. In the future, further randomized controlled trials may be needed.

      Key words

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        American Journal of Obstetrics & GynecologyVol. 209Issue 6
      • Staging laparoscopy for the management of early-stage ovarian cancer: a metaanalysis
        American Journal of Obstetrics & GynecologyVol. 209Issue 6
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          With interest we read the recently published article by Park et al,1 who reported the results of a metaanalysis of surgical outcomes in patients with apparent early-stage ovarian cancer that was staged by laparoscopy. Well-known advantages of the laparoscopic approach (eg, reduced blood loss) were confirmed, and it was stated that “the operative outcomes of a laparoscopic approach in patients with epithelial ovarian cancer could be compatible with those of laparotomy.” Despite the fact that the advantages of laparoscopy are of great benefit for patients with benign diseases and in selected patients with endometrial cancer and cervical cancer, its merit in early ovarian cancer is debatable.
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