Abstract
Background and objective: according to the latest ESMO−ESGO recommendations, laparotomy is the standard surgical approach to treat and stage patients with presumed early stage epithelial ovarian cancer (EOC). A few studies have investigated the efficacy and the safety of laparoscopy for the staging of early stage EOC, and this question is still in the center of debates. Recurrence-free survival (RFS) and overall survival (OS) benefits of the minimally invasive surgery (MIS) have still to be specified. The aim of this multicenter and retrospective study is to assess the survival outcomes of laparoscopic staging in comparison with laparotomic staging for patients presenting with an early stage EOC. Methods: data of patients with early stage EOC (FIGO I-IIA) who underwent primary surgery between 2000 and 2018 were extracted from the FRANCOGYN database. OS and RFS of these two groups, constituted according to the surgical route, were compared using Log rank test. Results: of the 144 patients included, 107 patients underwent laparotomy and 37 underwent laparoscopy for a staging purpose. The median follow-up was 36.0 months (18.0 to 58.0). For the laparoscopy and the laparotomy group, the median follow-up period was 24 (11.0 to 50.0) and 42.0 (24.0 to 66.0) months, respectively, (p < 0.001). Tumor recurrence occurred in 33 (23%) patients: 2 (5.4%) in the laparoscopy group and 31 (29%) in the laparotomy group (p = 0.08). The OS rate at 5 years was 97.3% after laparoscopy and 79.8% after laparotomy (p = 0.19). Conclusions: there is no difference associated with the laparoscopic approach for the staging of early stage EOC on RFS and OS in comparison with laparotomy. MIS may be proposed as a safe and adequate alternative to laparotomy when performed by well-trained surgeons.
Highlights
Epithelial ovarian cancer (EOC) is the eighth most common female cancer affecting women in developed countries and strikes one in 70 women [1]
The standard treatment for early stage EOC consists of total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy, peritoneal cytology, multiple intra-abdominal biopsies and pelvic/para-aortic lymphadenectomy by laparotomy followed in most cases by adjuvant platinum-based chemotherapy [1]
Stage EOC was defined by stage Federation of Gynecology and Obstetrics (FIGO) I−IIA according to FIGO 2014 classification [15] which means cancer was confined to the ovaries with possible cancer cells in the intra-abdominal fluid secretion or extended to the uterus/the fallopian tubes without cancer cells in the abdominal cavity
Summary
Epithelial ovarian cancer (EOC) is the eighth most common female cancer affecting women in developed countries and strikes one in 70 women [1]. The standard treatment for early stage EOC consists of total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy (when indicated depending on histology), peritoneal cytology, multiple intra-abdominal biopsies and pelvic/para-aortic lymphadenectomy (except for stage I expansive mucinous tumor) by laparotomy followed in most cases by adjuvant platinum-based chemotherapy [1]. The purpose of this surgical management is to assess the final stage of disease and adapt adjuvant therapies and follow-up with minimum perioperative morbidity−mortality. The performance of this surgical staging is decisive for the prognosis
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