Comparison of the survival outcomes of laparoscopy versus laparotomy in treatment of early-stage ovarian cancer: a systematic review and meta-analysis

Abstract

Background Laparoscopy has been widely used for patients with early-stage epithelial ovarian cancer (eEOC). However, there is limited evidence regarding whether survival outcomes of laparoscopy are equivalent to those of laparotomy among patients with eEOC. The result of survival outcomes of laparoscopy is still controversial. The aim of this meta-analysis is to analyze the survival outcomes of laparoscopy versus laparotomy in the treatment of eEOC. Methods According to the keywords, Pubmed, Embase, Cochrane Library and Clinicaltrials.gov were searched for studies from January 1994 to January 2021. Studies comparing the efficacy and safety of laparoscopy versus laparotomy for patients with eEOC were assessed for eligibility. Only studies including outcomes of overall survival (OS) were enrolled. The meta-analysis was performed using Stata software (Version 12.0) and Review Manager (Version 5.2). Results A total of 6 retrospective non-random studies were included in this meta-analysis. The pooled results indicated that there was no difference between two approaches for patients with eEOC in OS (HR = 0.6, P = 0.446), progression-free survival (PFS) (HR = 0.6, P = 0.137) and upstaging rate (OR = 1.18, P = 0.54). But the recurrence rate of laparoscopic surgery was lower than that of laparotomic surgery (OR = 0.48, P = 0.008). Conclusions Laparoscopy and laparotomy appear to provide comparable overall survival and progression-free survival outcomes for patients with eEOC. Further high-quality studies are needed to enhance this statement.

Robot-assisted laparoscopic staging compared to conventional laparoscopic staging and laparotomic staging in clinical early stage ovarian carcinoma

“…After RALS, similar overall, peri- and postoperative complication rates were found in comparison to conventional laparoscopic staging in all included cohort-studies (Table 2) [20–23,24 ▪ ]. RALS and conventional laparoscopic staging have similar EBL and LHS (Table 3) [16,17,19], as becomes clear in the studies of Nezhat et al [20] , Bellia et al [21] and Gallotta et al [22].…”

“…There is no evidence that RALS is better than conventional laparoscopic staging. In general, numbers of retrieved lymph nodes do not depend on surgical approach [17,18,[20][21][22]24 & ], only one study shows a slightly larger number of lymph nodes harvested using RALS compared to conventional laparoscopic staging [23]. RR in MIS is not higher and in one study even lower compared to laparotomy, but follow-up is still short and insufficient.…”

“…Most used oncologic outcome measures in the included cohort-studies were OS and RFS. These outcomes are shown in Table 6[21,22,24 ▪ ]. OS at the end of follow up was in none of studies significantly different between the two staging methods.…”

Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review.

“…Moreover, the minimally invasive approach has been independently associated with tumor rupture (adjusted relative risk, 1.17; 95% CI: 1.06–1.29) [ 64 ]. In contrast, recent meta-analyses showed that: a) the upstaging and cyst rupture rates are comparable in MIS and laparotomy [ 66 ], b) the negative prognostic impact of iatrogenic tumor rupture is not proven [ 67 ], and c) neither the 3-year nor 5-year disease-free survival nor overall survival differs between patients undergoing MIS and those operated on by an open approach [ 67 – 69 ].…”

The use of lidocaine and ketamine in the setting of abdominal surgery

“…Laparotomija je tradicionalni kirurški pristup koji omogućava direktnu vizualizaciju organa putem velike incizije na abdomenu što podra zumijeva vrlo opsežnu kiruršku ozljedu. Laparosko pija, s druge strane, je minimalno invazivni kirurški pristup koji ima prednost u vidu smanjene veličine incizije, a time i niže učestalosti poslijeoperacijskih komplikacija i bržeg poslijeoperacijskog oporavka 2 . S napretkom endoskopske kirurgije, laparotomija se sve rjeđe koristi, ali je još uvijek primarni izbor u hitnoći i situacijama kad intraabdominalno stanje nije moguće zbrinuti drugom tehnikom 3 .…”