Relevance of Laparoscopic Surgery for Ovarian Cancer in Well-selected Patients: A Propensity-matched Comparison With Laparotomy

Background/Aim: This study aimed to evaluate the relevance of laparoscopy in comparison with laparotomy in the management of ovarian cancer in well-selected patients. Patients and Methods: Data of consecutive ovarian cancer patients treated by laparoscopy were matched 1:1 to a cohort of patients operated by laparotomy using a propensity score matching. The inclusion criteria included patients who underwent a complete staging procedure in the early stages and optimal upfront or interval debulking surgery for advanced ovarian cancer. Results: In total, 153 patients were included. Propensity score matching led to the analysis of 41 well-balanced pairs of patients. For a median follow-up of 34.0 [19.0-64.0] months and 38.0 [24.5-75.0] months, respectively, no difference was found between the two groups in regards to overall survival (p=0.28) and disease-free survival (p=0.89). Conclusion: In well-selected patients, laparoscopic surgery may be a safe and effective alternative to laparotomy.

[1]  L. Lecointre,et al.  Three and Five-Year Mortality in Ovarian Cancer after Minimally Invasive Compared to Open Surgery: A Systematic Review and Meta-Analysis , 2020, Journal of clinical medicine.

[2]  D. Timmerman,et al.  ESMO-ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease†. , 2019, Annals of oncology : official journal of the European Society for Medical Oncology.

[3]  A. Secord,et al.  Surgical complexity score and role of laparoscopy in women with advanced ovarian cancer treated with neoadjuvant chemotherapy. , 2019, Gynecologic oncology.

[4]  G. Scambia,et al.  The INTERNATIONAL MISSION study: minimally invasive surgery in ovarian neoplasms after neoadjuvant chemotherapy , 2019, International Journal of Gynecologic Cancer.

[5]  P. Ramirez Interval cytoreduction for advanced ovarian cancer: is minimally invasive surgery ready for the next prospective randomized trial? , 2019, International Journal of Gynecological Cancer.

[6]  Jubilee Brown,et al.  When Less Is More: Minimally Invasive Surgery Compared with Laparotomy for Interval Debulking After Neoadjuvant Chemotherapy in Women with Advanced Ovarian Cancer. , 2018, Journal of minimally invasive gynecology.

[7]  V. Gebski,et al.  Minimally Invasive versus Abdominal Radical Hysterectomy for Cervical Cancer , 2018, The New England journal of medicine.

[8]  S. Uccella,et al.  Laparoscopy for primary cytoreduction with multivisceral resections in advanced ovarian cancer: prospective validation. “The times they are a-changin”? , 2018, Surgical Endoscopy.

[9]  G. Bogani,et al.  Laparoscopy Compared With Laparotomy for Debulking Ovarian Cancer After Neoadjuvant Chemotherapy. , 2017, Obstetrics and gynecology.

[10]  M. Berry,et al.  Reporting and Guidelines in Propensity Score Analysis: A Systematic Review of Cancer and Cancer Surgical Studies , 2017, Journal of the National Cancer Institute.

[11]  G. Bogani,et al.  Minimally Invasive Surgical Staging for Ovarian Carcinoma: A Propensity-Matched Comparison With Traditional Open Surgery. , 2017, Journal of minimally invasive gynecology.

[12]  G. Scambia,et al.  Minimally invasive versus standard laparotomic interval debulking surgery in ovarian neoplasm: A single-institution retrospective case-control study. , 2016, Gynecologic oncology.

[13]  T. Lawrie,et al.  Laparoscopy versus laparotomy for FIGO stage I ovarian cancer. , 2016, The Cochrane database of systematic reviews.

[14]  J. Black,et al.  The role of minimally invasive interval debulking surgery in advanced epithelial ovarian cancer , 2016, Expert review of anticancer therapy.

[15]  B. Ataseven,et al.  Prognostic Impact of Port-Site Metastasis After Diagnostic Laparoscopy for Epithelial Ovarian Cancer , 2016, Annals of Surgical Oncology.

[16]  W. Kuhn,et al.  Impact of Open Laparoscopy in Patients Under Suspicion of Ovarian Cancer. , 2016, Anticancer research.

[17]  Chongdong Liu,et al.  Comparison of Laparoscopy and Laparotomy in Surgical Staging of Apparent Early Ovarian Cancer , 2016, Medicine.

[18]  G. Scambia,et al.  Current Recommendations for Minimally Invasive Surgical Staging in Ovarian Cancer , 2016, Current Treatment Options in Oncology.

[19]  W. Gotlieb,et al.  Laparoscopic and robot-assisted hysterectomy for uterine cancer: a comparison of costs and complications. , 2015, American journal of obstetrics and gynecology.

[20]  C. Köhler,et al.  Oncologic Concerns regarding Laparoscopic Cytoreductive Surgery in Patients with Advanced Ovarian Cancer Submitted to Neoadjuvant Chemotherapy , 2015, Oncology.

[21]  M. Gasparri,et al.  Implementation of laparoscopic approach for type B radical hysterectomy: a comparison with open surgical operations. , 2015, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[22]  Ying Zhang,et al.  Effect of CO2 pneumoperitoneum on the proliferation of human ovarian cancer cell line SKOV-3 and the expression of NM23-H1 and MMP-2 , 2015, Archives of Gynecology and Obstetrics.

[23]  F. Ghezzi,et al.  Laparoscopic and Open Abdominal Staging for Early-Stage Ovarian Cancer: Our Experience, Systematic Review, and Meta-analysis of Comparative Studies , 2014, International Journal of Gynecologic Cancer.

[24]  M. Leeflang,et al.  Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer. , 2014, The Cochrane database of systematic reviews.

[25]  G. Scambia,et al.  Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience. , 2013, Gynecologic oncology.

[26]  P. Austin,et al.  Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies , 2010, Pharmaceutical statistics.

[27]  Young Tae Kim,et al.  Comparisons of Surgical Outcomes, Complications, and Costs Between Laparotomy and Laparoscopy in Early-Stage Ovarian Cancer , 2010, International Journal of Gynecologic Cancer.

[28]  W. Cliby,et al.  Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. , 2007, American journal of obstetrics and gynecology.

[29]  N. Demartines,et al.  Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey , 2004, Annals of Surgery.

[30]  J. Hurteau,et al.  Effect of carbon dioxide on human ovarian carcinoma cell growth. , 2001, American journal of obstetrics and gynecology.

[31]  M. Canis,et al.  Tumor growth and dissemination after laparotomy and CO2 pneumoperitoneum: a rat ovarian cancer model. , 1998, Obstetrics and gynecology.