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Minimally Invasive Surgery for the Management of Ovarian Cancer: A Systematic Review and Meta-analysis
Farr Nezhat1, Camille Briskin1, Nisha Lakhi1
1Weill Cornell Medical College of Cornell University, New York, New York University, Langone Hospital, Long Island School of Medicine, Mineola, New York Medical College School of Medicine, Valhalla, and Richmond University Medical Center, Staten Island, New York; the University of Massachusetts, Worcester, Massachusetts; and the School of Public Health, Oregon Health & Science University, Portland, and Providence Medical Center, Medford, Oregon.
Minimally invasive surgery (MIS) shows comparable survival outcomes to laparotomy for early-stage ovarian cancer. For advanced stages, MIS may offer slight advantages in optimal debulking rates, with similar outcomes for interval debulking.
Area of Science:
- Gynecologic Oncology
- Surgical Oncology
- Evidence-Based Medicine
Background:
- Ovarian cancer management involves surgical staging and cytoreduction.
- Minimally invasive surgery (MIS) and laparotomy are surgical approaches.
- Comparative outcomes data for MIS versus laparotomy in ovarian cancer are needed.
Purpose of the Study:
- To compare perioperative and survival outcomes of MIS versus laparotomy in ovarian cancer.
- Analysis focused on early-stage disease, primary cytoreduction for advanced disease, and interval debulking.
Main Methods:
- A comprehensive literature search was performed across multiple databases (PubMed, MEDLINE, Web of Science, etc.) from 1994 to May 2024.
- Included studies compared MIS with laparotomy for ovarian cancer staging and reported outcomes.
- Thirty-six nonrandomized studies were included after screening 2,777 citations; no randomized controlled trials were identified.
Main Results:
- For early-stage ovarian cancer, no significant differences in progression-free or overall survival were observed between MIS and laparotomy.
- For primary cytoreduction in advanced ovarian cancer, MIS slightly favored optimal debulking rates.
- For interval debulking after neoadjuvant chemotherapy, rates of optimal debulking were similar between MIS and laparotomy.
Conclusions:
- Observational studies included in this review have limitations due to potential bias.
- MIS may provide perioperative benefits and is a viable option for selected ovarian cancer patients.
- Survival outcomes for early-stage disease are comparable, and optimal debulking rates are similar for advanced disease between MIS and laparotomy.
