Abstract
BackgroundThe primary treatment for advanced ovarian cancer is aggressive cytoreductive surgery (CRS), which is associated with considerable morbidity. The aim of this meta-analysis is to compare morbidity associated with primary CRS and secondary CRS for recurrent disease.MethodsA literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for publications reporting morbidity and mortality in patients undergoing CRS in primary and recurrent ovarian malignancy. Embase, Medline, Pubmed, Pubmed Central, clinicaltrials. gov and Cochrane databases were searched. Two independent reviewers applied inclusion and exclusion criteria to select included papers. A total of 215 citations were reviewed; 6 studies comprising 641 patients were selected for the analysis.ResultsResults were reported as mean differences or pooled odds ratios (OR) with 95 % confidence intervals (95 % CI). The overall morbidity rate was 38.4 %, and this did not differ between the two groups (p=0.97). This did not change when only Clavien-Dindo grade 3 and 4 morbidities were accounted for (14 % primary CRS, 15 % recurrent, p=0.83). Compared to primary CRS, secondary CRS was associated with a similar operative time (mean 400 min, I2=79 %, p=0.45), rate of bowel resection (I2=75 %, p=0.37) and transfusion requirements (MD – 0.7 L, I2=76 %, p=0.45). The mortality rate in both groups was too low to allow for meaningful meta-analysis, with four deaths in the group undergoing primary cytoreductive surgery (1.0 %) and two deaths in the group with recurrent disease (0.9 %).ConclusionsIn conclusion, secondary CRS for recurrent ovarian cancer is a safe and feasible option in carefully pre-selected patients with comparable morbidity to primary CRS.
Highlights
Ovarian cancer is the ninth leading cause of cancer in women, but the fifth leading cause of all cancer-related deaths [1]
The purpose of this metaanalysis is to review the morbidity and mortality associated with cytoreductive surgery in patients with primary and recurrent ovarian malignancy to assess if secondary CRS is comparable in terms of surgical complications
No study scored less than 15 when MINORS criteria were applied, and a sensitivity analysis was not required. This meta-analysis demonstrates that secondary CRS can be performed with a similar morbidity and mortality as primary CRS in advanced ovarian cancer
Summary
Ovarian cancer is the ninth leading cause of cancer in women, but the fifth leading cause of all cancer-related deaths [1]. Patients treated in specialist centers where a large volume of CRS are performed have shown improved survival and reduced morbidity [10] The purpose of this metaanalysis is to review the morbidity and mortality associated with cytoreductive surgery in patients with primary and recurrent ovarian malignancy to assess if secondary CRS is comparable in terms of surgical complications. A systematic literature search was performed for all publications that reported on morbidity and mortality in patients undergoing cytoreductive surgery in primary and recurrent ovarian malignancy. Corresponding funnel plots of log standard error as a function of effect size were used to examine the effect of publication bias visually Subgroup analysis of those studies utilizing Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) in addition to CRS was performed, and sensitivity analysis omitted studies if they scored poorly for methodological quality (MINORS score
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