Comparison of Laparoscopy and Laparotomy in the Management of Early-stage Ovarian Cancer

Abstract

Objectives: The objective of this study was to assess the feasibility of minimally invasive surgery for early-stage ovarian cancer (EOC) by comparing the surgical and survival outcomes between laparoscopy and laparotomy. Materials and Methods: This was a retrospective, single-center observational study that included all patients who underwent surgical staging for EOC by laparoscopy or laparotomy between 2010 and 2019. Results: Forty-nine patients were included; of which 20 underwent laparoscopy, 26 laparotomy, and three conversion from laparoscopy to laparotomy. No significant differences were observed between the two groups regarding operative time, number of lymph nodes dissected, or intraoperative tumor rupture rate, while estimated blood loss and transfusion requirements were lower in the laparoscopy group. The complication rate tended to be higher in the laparotomy group. Patients in the laparoscopy group had a faster recovery, with earlier urinary catheter and abdominal drain removal, shorter hospital stay, and a trend toward earlier tolerance of oral diet and mobilization. At a mean follow-up of 45.7 months, 14 patients had disease recurrence, with no differences in the mean progression-free survival between the two groups (36 months for laparoscopy vs. 35.5 months for laparotomy, P = 0.22). Conclusion: Laparoscopic surgery performed by a trained gynecological oncologist is a safe and effective surgical approach for comprehensive staging of EOC, with the additional benefits of a faster recovery compared to laparotomy.

Efficacy and safety of minimally invasive laparoscopic surgery under general anesthesia for ovarian cancer

“…However, early-stage ovarian cancer usually presents no characteristic symptoms, making diagnosis relatively difficult. Approximately 70% of ovarian cancer patients are diagnosed in the late stage, resulting in a poor prognosis with a 5-year survival rate of less than 30%[ 2 - 4 ]. Therefore, early and accurate diagnosis as well as standardized treatment can better improve the prognosis of ovarian cancer patients[ 5 ].…”

The Era of 4K Three-dimensional Imaging is Coming

“…These improved features not only aid the laparoscopists in the ease and safety of performing simple minimally invasive gynecologic surgery and fertility-sparing procedures but, more importantly, they become invaluable in procedures where precise anatomic and tissue identification, dissection, and removal of lesions are necessary and crucial, such as in cases of deeply infiltrating endometriosis and oncologic staging surgery where procedures may be technically complicated and risk of bowel or ureteral injuries are higher possibly due to dense adhesions. [ 14 15 16 ] It can potentially further minimize the margin for surgical error, reduce complications, and optimize surgical interventions. 4K 3D imaging makes the standardization of radical hysterectomy feasible.…”