Laparoscopy versus laparotomy for FIGO stage 1 ovarian cancer (Review)

Abstract

Background Over the past ten years laparoscopy has become an increasingly common approach for the surgical removal of early stage ovarian tumours. There remains uncertainty about the value of this intervention. This review has been undertaken to assess the available evidence of the benefits and harms of laparoscopic surgery for the management of early stage ovarian cancer compared to laparotomy. Objectives To evaluate the benefits and harms of laparoscopy in the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic) when compared with laparotomy. Search methods Trials were identified by searching the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL),TheCochrane Library Issue 2, 2007,MEDLINE (January 1990 toNovember 2007), EMBASE (1990 toNovember 2007), LILACS (1990 toNovember 2007), BIOLOGICALABSTRACTS (1990 toNovember 2007) andCancerlit (1990 toNovember 2007). We also searched our own publication archives, based on prospective handsearching of relevant journals from November 2007. Reference lists of identified studies, gynaecological cancer handbooks and conference abstract were also scanned. Selection criteria Studies including patients with histologically proven stage I ovarian cancer according to the International Federation of Gynaecology and Obstetrics (FIGO). Studies comparing laparoscopic surgery with laparotomy for early stage ovarian cancer were only available from1990. It was anticipated that a very small number of randomised controlled trials (RCTs) were conducted studying themanagement of early stage ovarian cancer. Therefore, non-randomised comparative studies, cohort studies and case-controls studies, but not studies with historical controls, were also considered. Data collection and analysis Data extraction was performed independently by five review authors (LRM, DDR, MIR, MCB and MIE) who assessed study quality and quality of extracted data. Extracted data included trial characteristics, characteristics of the study participants, interventions and outcomes. The quality of non RCTs was assessed using appropriate quality evaluations tools from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and from the Newcastle-Ottawa tool for observational studies (NOS). Main results No RCTs were identified. Three observational studies were identified. Authors’ conclusions This review has found no evidence to help quantify the value of laparoscopy for the management of early stage ovarian cancer as routine clinical practice.