Is it the time for laparoscopic management of early-stage ovarian malignancies?

Abstract

The laparoscopic management of early-stage ovarian cancer remains controversial. Some surgeons hesitate to perform laparoscopic staging due to concern with the adequacy of staging, the possibility of tumor spillage and risk of port-site metastasis. Previous studies and literature reviews have reinforced the argument and supported the use of laparoscopy. However, the results were drawn with limited sample size obtained from case-series and case–control studies which result in difficult to make definite conclusions. Till date, the list of laparoscopic procedures has grown at a pace consistent with improvements in technology and technical skill of the surgeon. The number of studies with larger sample size, more prospective data, and longer duration of follow-up has been increasing. This review serves as an update on safety, feasibility, surgical, and oncological outcomes in cases of early-stage ovarian cancer treated by laparoscopic surgery of the literature published since 2008. We aim to clarify whether laparoscopy is safe and effective enough to be considered as standard management. Rely on nonrandomize studies, the current clinical evidence supports the role of laparoscopy in the management of early-stage ovarian cancer. Laparoscopy appears to offer several perioperative benefits without compromise of surgical morbidity and oncological outcome.

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

“…The main factor influenced intraperitoneal spillage might be the size of tumor. Larger tumors might be more likely to rupture [ 24 ]. The studies included in this study did not reported the information about intraperitoneal spillage.…”

Primary Laparoscopic Surgery Does Not Affect the Prognosis of Early-Stage Ovarian Clear Cell Cancer

“… 18 Second, MIS may cause intraoperative cancer cell spillage, leading to peritoneal dissemination or port-site metastasis. 19–21 Third, we still do not know if carbon dioxide (CO 2 ) pneumoperitoneum changes the tumor environment or the biological behavior of tumor cells; thus, promoting tumor spread or metastasis.…”

“…18 Second, MIS may cause intraoperative cancer cell spillage, leading to peritoneal dissemination or port-site metastasis. [19][20][21] Third, we still do not know if carbon dioxide (CO 2 ) pneumoperitoneum changes the tumor environment or the biological behavior of tumor cells; thus, promoting tumor spread or metastasis. We found no survival differences, when we reviewed previous studies comparing the survival of patients with early-stage ovarian cancer between laparoscopic and open surgery groups; however, the study designs or the included patients differed in the studies.…”

The attributive value of comprehensive surgical staging in clinically early-stage epithelial ovarian carcinoma: A systematic review and meta-analysis

“…Its long-term sequelae, such as lymphedema caused by lymphadenectomy, manifest in over 30% of the patients, and negatively influence the quality of life [40,41]. A laparoscopic approach could reduce some of the surgical morbidity, though further trials would be required before a definitive statement can be made about the clinical value of laparoscopic staging [42][43][44].…”