Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety

Abstract

The aim of this study was to compare laparoscopic and laparotomic surgical staging in patients with stage I epithelial ovarian cancer in terms of feasibility and safety. A retrospective chart review was undertaken of all patients with apparent stage I epithelial ovarian cancer who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) surgical staging at the Center for Uterine Cancer, National Cancer Center, Korea, between January 2001 and August 2006. During the study period, 19 patients underwent laparotomic surgical staging and 17 patients underwent laparoscopic surgical staging. No cases were converted from laparoscopy to laparotomy. The two groups were similar in terms of age, body mass index, procedures performed, number of lymph nodes retrieved, and operating time. The laparoscopy group had less estimated blood loss (P = 0.001), faster return of bowel movement (P < 0.001), and a shorter postoperative hospital stay (P = 0.002) compared to the laparotomy group. Transfusions were required only in two laparotomy patients, and postoperative complications occurred only in four laparotomy patients. However, two patients with stage IA grade 1 and 2 disease in laparoscopy group had recurrence with one patient dying of disease. The accuracy and adequacy of laparoscopic surgical staging were comparable to laparotomic approach, and the surgical outcomes were more favorable than laparotomic approach. However, the oncologic safety of laparoscopic staging was not certain. This is the first report on the possible hazards of laparoscopic staging in early-stage ovarian cancer. In the absence of a large prospective trial, this technique should be performed cautiously.

Laparoscopic Adnexectomy with Peritonectomy for an Ovarian Tumor Adhered to the Pelvic Sidewall

“…Data on the rate of cyst rupture during the laparoscopy and laparotomy approaches is conflicted. In general, tumor rupture rates were reported to range from 10.5 to 41.8% [12,13]. These rates may vary, based on the planned procedure, such as cystectomy versus adnexectomy [14].…”

Management of a Suspicious Adnexal Mass: A Clinical Practice Guideline

“…A total of 1809 articles were identified in the updated search for the most appropriate surgical procedure, of which sixteen met the inclusion criteria [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] .…”

“…In the three studies [21][22][23] that considered patients with early epithelial ovarian cancer, no statistical difference in survival rates was detected between patients undergoing laparoscopy and those undergoing laparotomy. In the management of patients with early borderline ovarian tumours, Romangnolo et al 24 , Park et al 25 , and Desfeux et al 20 found that the surgical approach-laparoscopic or laparotomic-did not appear to influence survival rates.…”

“…This recommendation is based on the results of six retrospective cohort studies [20][21][22][23][24][25] . In the three studies [21][22][23] that considered patients with early epithelial ovarian cancer, no statistical difference in survival rates was detected between patients undergoing laparoscopy and those undergoing laparotomy.…”

Asian society of gynecologic oncology workshop 2010

“…41 The Although ongoing surveillance, attention to technique, and appropriate management of port sites are mandatory, the laparoscopic management of early ovarian cancer seems to be justified by the significant reduction in morbidity, hospital stay, and recovery time that result from this surgical approach and by lack of any solid evidence that if used properly by qualified individuals it does not harm. 42 In conclusion, primary surgical staging is the standard procedure in early ovarian cancer but some considerations must be given to the variable situations. Although laparoscopic staging for ovarian cancer is controversial, it may be an alternative approach for early ovarian cancer.…”