Abstract
BackgroundThe aim of this systematic review was to investigate the accuracy of additional staging laparoscopy (SL) in advanced epithelial ovarian cancer (AEOC) to predict futile laparotomy (FL).MethodsSystematic review according to preferred reporting items for systematic reviews and meta-analyses statement (PRISMA) criteria. Clinical studies investigating the role of SL in selecting women with AEOC for primary debulking surgery (PDS) were included. Index test: SL. Reference test: laparotomy. Target condition: incomplete cytoreduction (CR) with remaining disease<1 cm.ResultsNine prospective and retrospective studies reporting on eight cohorts totalizing 778 LS were included. Reference test was completed in 76 % cases. PPV for FL was between 0.69 and 1.0. In three studies examining the value of a predictive index value (PIV) for predicting FL, sensitivity of the index test (LS with PIV ≥8) was between 46% and 70 %, and specificity between 89 % and 100 %. The proportion of patients that received CR during PDS differed widely between studies (from 50 to 91). Using a PIV did not increase the sensitivity and might result in more patients receiving FL. In the only randomized trial, FL occurred in 10 (10 %) of 102 patients in the LS group versus 39 (39 %) of 99 patients in the primary PDS group (relative risk, 0.25; 95 % CI, 0.13–0.47; p<0.001). Port-site recurrences occurred in 2%–6 % patients. Overall costs of with or without SL were comparable.ConclusionsThe evidence available from this systematic review supports the inclusion of an additional LS to the conventional initial diagnostic workup in women with AEOC.
Highlights
Epithelial ovarian cancer (EOC) is the leading cause of gynaecologic cancer death in Western countries [1]
Two studies reported about the same patient cohort, the first one for analysing accuracy of laparoscopic staging (LS), the second one for validating a scoring system [28, 29]
Determining the best therapeutic strategy is essential in women with EOC: One the one hand, complete CRS should be achieved but, on the other hand, the number of futile laparotomies should be minimal
Summary
Epithelial ovarian cancer (EOC) is the leading cause of gynaecologic cancer death in Western countries [1]. A majority of women with EOC are diagnosed at advanced stage of disease. In a Cochrane review, there were no RCTs identified that were designed to evaluate the effectiveness of surgery when performed as a primary procedure in advanced stage ovarian cancer. The aim of this systematic review was to investigate the accuracy of additional staging laparoscopy (SL) in advanced epithelial ovarian cancer (AEOC) to predict futile laparotomy (FL). Clinical studies investigating the role of SL in selecting women with AEOC for primary debulking surgery (PDS) were included. In three studies examining the value of a predictive index value (PIV) for predicting FL, sensitivity of the index test (LS with PIV ≥ 8) was between 46% and 70 %, and specificity between 89 % and 100 %. The proportion of patients that received CR during PDS differed widely between studies (from 50 to 91).
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