Open Surgical Staging Research Articles

Minimally Invasive Staging of Early-Stage Epithelial Ovarian Cancer versus Open Surgery in Terms of Feasibility and Safety: A Systematic Review and Meta-Analysis.

Epithelial ovarian cancer is women's fourth most common oncological cause of death. One of the main prognostic factors in ovarian cancer is the tumor stage. For instance, surgical staging of the disease is focal when choosing the best therapeutic option for each case. Although open surgery is the prevalent approach for staging and treating ovarian cancer, the use of minimally invasive surgery (MIS) has found recent application in staging or restaging cases of early disease. Our work compares oncological outcomes after MIS staging for FIGO I epithelial ovarian cancer with the laparotomic approach. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations, we systematically searched the Pub Med and Scopus databases in February 2023. No temporal nor geographical limitation was made. We included the articles containing data about Disease-Free Survival (DFS) and Overall Survival (OS), Recurrence Rates (RR), and Upstaging Rates (UpR). We used comparative studies for the meta-analysis. After the database search and article selection, 19 works matched the inclusion criteria for the systematic review. Eleven of these were comparative studies between MIS and Open Surgical Staging (OSS) approaches for ovarian cancer staging and were included in the meta-analysis. The meta-analysis did not show a statistically significant difference between the MIS and the OSS group concerning DFS, OS, and RR. Only Upstaging Rate ≥ FIGO Stage II was statistically significative higher in the OSS group. Likewise, MIS is confirmed to be an approach with a lower profile of surgical complications. In conclusion, our study did not show one approach to be safer than the other. However, the lack of dedicated studies limits the evidence of our study. For instance, we recommend adequately selecting the specimen, minimizing the risk of spillage, and optimizing surgical staging.

Robotic surgery in early and advanced ovarian cancer: Case selection for surgical staging and interval debulking surgery

ObjectiveDuring the last decade several case series have been published on robotic surgery in early and advanced stage ovarian cancer. Although most studies lack a significant oncological follow-up, more importantly criteria for patient selection for both robotic surgical staging (R-SS) and robotic interval debulking surgery (R-IDS) are not well defined. The objective of this study was to assess the surgical and oncological outcomes, using well-defined selection criteria, between robotic and open surgery in early and advanced stage ovarian cancer. Study designSingle-center retrospective case cohort study including 96 ovarian cancer patients. For early stage ovarian cancer, patients were selected for R-SS after laparoscopic salpingo-oophorectomy of a suspicious adnexal mass. For advanced stage ovarian cancer, only patients receiving neoadjuvant chemotherapy and IDS were included in the study. Exclusion criteria were the presence of residual peritoneal disease after NACT and/or patients requiring additional complex surgical procedures. ResultsFor early stage ovarian cancer, similar median operative times were seen between R-SS and open surgical staging (O-SS), 132 min and 120 min respectively. Pelvic/para-aortic lymph node yield was similar between R-SS and O-SS, 22/11 nodes and 18/8 nodes respectively. Surgical upstaging occurred in 11.5% in the R-SS group and in 27.6% in the O-SS group. In advanced stage ovarian cancer, the BMI was significantly higher in the R-IDS group compared to the O-IDS group (27.8 vs 23.5; p =.006). The median follow was 52 months in the R-IDS group and 31 months in the O-IDS group. Recurrent disease occurred in 42.9% of the R-IDS group and in 45% of the O-IDS group. The length of hospitalization was significantly longer in the O-SS and O-IDS group (p <.00001). ConclusionPatients with clinically early stage ovarian cancer, confirmed after laparoscopic removal of a suspicious adnexal mass, are candidates for R-SS whilst maintaining similar surgical and oncological outcome measures as O-SS. In advanced ovarian cancer, suitable candidates for R-IDS are those who receive NACT with good response and no residual peritoneal disease, especially in patients with a high BMI, but large prospective randomized trials with well-defined criteria are needed.

Comparative Study of Laparoscopic versus Conventional Open Surgical Staging Procedure for Endometrial Cancer: Our Institutional Experience.

Objective:The aim of this study was to compare laparoscopic surgical staging of endometrial cancer with conventional open methods.Materials and Methods:The retrospective data were collected from 90 endometrial cancer patients who were operated between 2013 and 2018 in our government institution. The safety and morbidity of the two groups were compared based on mean operative time, blood loss, intraoperative complications, postoperative complication, etc., and the results were analyzed. Statistical analysis was performed using IBM SPSS statistics version 20. Clinical and pathologic factors were compared between two groups with Fisher's exact test and Student's t-test for data analysis. The survival data were analyzed using Kaplan–Meier survival curves. P < 0.05 was considered statistically significant.Results:Thirty-two patients underwent laparoscopic staging, 45 underwent laparotomy, and 13 cases lap converted to open surgery. The mean operative time for the laparoscopic procedure was lower than the open procedure (P = 0.001). The mean hospital stay of patients who underwent laparoscopic staging was around 7.1 days significantly less compared to the laparotomy group. Intraoperative blood loss of patients undergoing laparoscopic surgery was significantly less than that of the laparotomy group (P = 0.015). There was no statistically significant difference in nodal retrieval between laparotomy and laparoscopy group (P = 0.172). The mean duration of hospitalization was statistically significantly greater in the laparotomy group than the laparoscopic group (13 and 7 days, P < 0.001). Based on the Kaplan–Meier survival curve, there was no difference in survival rates between the groups. Median follow-up duration was 32 months.Conclusion:Laparoscopic surgical staging is oncologically safe for the management of endometrial cancer with acceptable morbidity compared to the open approach with far less blood loss and shorter postoperative stay.

Laparoscopic Versus Conventional Open Method for the Surgical Staging of Endometrial Carcinoma: A Comparative Study

Introduction: Before the advancement and improvement of techniques of using laparoscopy in total hysterectomy, it was considered as a procedure that carried a high risk of injury to the ureters but now with improvement of the experience, training and novel equipment, there is increase in the use of such procedure with lower incidence of ureteric injury. Recently, in surgical staging of endometrial carcinoma (EC); the laparoscopy role has been considered more beneficial. Many previous reports proved fewer complications, lower morbidity, shorter duration of postoperative hospitalization, and rabid recovery. But, the therapeutic benefits and drawbacks of using laparoscopy are not confirmed yet. Aim: The aim of current study was to assess the benefits and drawbacks of using laparoscopy in surgical staging of EC and comparing them with open surgical staging (laparotomy). Materials and Methods: the current study included 50 patients diagnosed with EC were included and were divided in to two groups the first group included 20 patients and was managed by laparoscopic staging, while the second group included 30 patients and was managed by laparotomy. We compared between using laparoscopy in surgical staging of EC with open surgical staging (laparotomy) regarding operative and postoperative outcomes. Results: laparoscopic method of staging had a significantly longer time of the operation than laparotomy (p=0.04), but it had lesser amount of blood loss intra-operatively (p<0.002). There were fewer number of resected lymph nodes (p=0.004) in the laparoscopic technique in contrast to laparotomy. Patients who underwent laparoscopy has a shorter time of postoperative staying in hospital in comparison to those who underwent laparotomy (p=0.012). More number of patients in the open group than the laparoscopy group underwent para-aortic lymphadenectomy (p<0.001). Conclusion: we have proved the benefits, disadvantages and the essential role of laparoscopy in treatment and surgical staging of EC. Laparoscopy is proved to be safe and effective technique with lower rates of blood loss and less rates of intra-and post-operative morbidity. Experienced surgeon could perform hysterectomy and lymphadenectomy with perfect cancer excision and staging as equally good to laparotomy.

Prospective Nonrandomized Comparative Study of Laparoscopic Versus Open Surgical Staging for Endometrial Cancer in India.

Laparoscopic procedures to treat endometrial cancer are currently emerging. At present, we have evidence to do laparoscopic oncologic resections for endometrial cancer as proven by many prospective studies from abroad such as LAP2 by GOG. So, we have decided to assess the safety and feasibility of such a study in our population with the following as our primary objectives: (1) to study whether laparoscopy is better compared to open approach in terms of duration of hospital stay, perioperative morbidity and early recovery from surgical trauma and (2) to study whether the laparoscopic approach is noninferior to the open approach in terms of number of lymph nodes harvested in lymphadenectomy and rate of conversion to open surgery. We did a prospective nonrandomized comparative study of open versus laparoscopy approach for surgical staging of endometrial cancer from 16th May 2013 to 15th May 2015. To prove a significant difference in the hospital stay, we needed 29 patients in each arm. Thirty patients in each arm were enrolled for the study. The median duration of stay in the open arm was 7days and in the laparoscopy arm it was 5days. The advantage of 2days in the laparoscopic arm was statistically significant (P value 0.006). Forty percent of patients in the open arm had to stay in the hospital for more than 7days whereas only 3% of patients in the laparoscopy arm required to stay for more than 7days (P value 0.001). This difference was statistically significant. There was no significant difference between the early complication rates between the two arms (20% in open vs. 13% in laparoscopy; P value 0.730). There was a conversion rate of 10% in laparoscopy. The median number of nodes harvested in open arm was 16.50 and in the laparoscopy arm, it was 13.50. The difference was not statistically significant (P value 0.086). Laparoscopy approach for endometrial cancer staging is feasible in Indian patients and the short-term advantages are replicable with same oncologic safety as proved by randomized controlled trials.

Minimally Invasive Surgical Staging for Ovarian Carcinoma: A Propensity-Matched Comparison With Traditional Open Surgery

Study ObjectiveGrowing evidence supports the safety of a laparoscopic approach for patients affected by apparent early-stage ovarian cancer. However, no well-designed studies comparing laparoscopic and open surgical staging are available. In the present investigation we aimed to provide a balanced long-term comparison between these 2 approaches. DesignRetrospective study (Canadian Task Force classification II-2). SettingTertiary center. PatientsData of consecutive patients affected by early-stage ovarian cancer who had laparoscopic staging were matched 1:1 with a cohort of patients undergoing open surgical staging. The matching was conducted by a propensity-score comparison. InterventionLaparoscopic and open surgical staging. Measurements and Main ResultsFifty patient pairs (100 patients: 50 undergoing laparoscopic staging vs 50 undergoing open surgical staging) were included. Demographic and baseline oncologic characteristics were balanced between groups (p > .2). We observed that patients undergoing laparoscopic staging experienced longer operative time (207.2 [71.6] minutes vs 180.7 [47.0] minutes; p = .04), lower blood loss (150 [52.7] mL vs 339.8 [225.9] mL; p < .001), and shorter length of hospital stay (4.0 [2.6] days vs 6.1 [1.6] days; p < .001) compared with patients undergoing open surgical staging. No conversion to open surgery occurred. Complication rate was similar between groups. No difference in survival outcomes were observed, after a mean (SD) follow-up of 49.5 (64) and 52.6 (31.7) months after laparoscopic and open surgical staging, respectively. ConclusionsOur findings suggest that the implementation of minimally invasive staging does not influence survival outcomes of patients affected by early-stage ovarian cancer. Laparoscopic staging improved patient outcomes, reducing length of hospital stay. Further large prospective studies are warranted.

Laparoscopic surgical staging in women with early stage epithelial ovarian cancer performed by recently certified gynecologic oncologists

ObjectiveTo compare the surgical and oncological outcomes of laparoscopic versus open surgical staging in patients with early stage ovarian cancer performed by recently certified gynecologic oncologists. Study designA retrospective comparative observational study was performed, which included women who had undergone laparoscopic comprehensive surgical staging for early stage epithelial ovarian cancer between June, 2008 and January, 2014. Patients were compared with women who had undergone laparotomic staging between June, 2006 and January, 2014. ResultsA total of 50 and 58 patients underwent, laparoscopic and laparotomy surgical staging, respectively. The patients’ baseline characteristics were similar in both groups. Women in the laparoscopy group had a significantly lower preoperative CA-125 value (p=0.01). The operative time was similar between groups. The patients in the laparotomy group had significantly higher estimated blood loss (p≤0.001) and larger ovarian masses (p=0.001). Estimated blood loss was significantly higher in laparotomy versus laparoscopy; median (IQ range) 200 (200–225) ml and 500 (300–1000) ml (p≤0.0001). Intraoperative complications and postoperative complication rate was similar in both groups regardless of the type of surgical procedure; and laparoscopy was associated with a significantly shorter length of the hospital stay (p≤0.001). The number of lymph node retrieved and upstaging rate, as well as progression free survival and overall survival rates, were similar in both groups. ConclusionsLaparoscopic surgical staging of apparent early stage ovarian cancer has similar surgical and oncological outcomes to laparotomy when recently certified gynecologic oncologists perform the procedures.

Pathologic and treatment outcomes among a geriatric population of endometrial cancer patients: A Gynecologic Oncology Group ancillary data study

Objective: To report the surgicopathologic findings, postoperative complications, and outcomes in a subset of 715 pts ≥70 years old (yo) who participated in the GOG Lap2 trial, a randomized comparison of laparoscopic versus open surgical staging in clinically early-stage endometrial cancer (EC).

Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer

Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer

Comparison between 155 cases of robotic vs. 150 cases of open surgical staging for endometrial cancer

ObjectiveTo compare the outcomes of 155 cases of endometrial cancer who had robot-assisted surgical staging to 150 open cases. MethodsRetrospective chart review of cases of endometrial cancer that underwent staging two different ways by two surgeons at an academic institution. ResultsMean age was 62.4years in the robotic arm and 65 (P=0.04) in the open arm. Mean body mass index was 34.5Kg/m2 in the robotic arm and 33Kg/m2 in the open arm (P=0.2). Pelvic and para-aortic lymph node dissection were performed in 94.8% and 67.7% of the robotic cases versus 95.3% and 74% of the open cases, respectively. Mean operative time was 127min in the robotic arm, and 141min in the open arm (P=0.0001). Mean lymph node count was 20.3 in the robotic arm, and 20 in the open arm (P=0.567). Mean estimated blood loss was 119ml in the robotic arm and 185 in the open arm (P=0.015). Mean hospital stay was 1.5days in the robotic arm, and 4days in the open arm (P=0.0001). The incidence of postoperative ileus (0.6% vs. 10.7%, P=0.0001), infections (5.2% vs. 24%, P=0.0001), anemia/transfusion (1.3% vs. 7.7%, P=0.005), and cardiopulmonary complications (3.2% vs.14.7%, P=0.003) was significantly lower in the robotic arm vs. the open arm. There was one death in the robotic arm attributed to pre-existing cardiac condition. ConclusionRobotic-assisted staging reaps the benefits of minimally invasive surgery without compromising the adequacy of the procedure. Dedication to the technique shortens the operative time.

Comparison of Laparoscopic Versus Conventional Open Surgical Staging Procedure for Endometrial Cancer

Comparison of Laparoscopic Versus Conventional Open Surgical Staging Procedure for Endometrial Cancer

Comparison between 150 Cases of Robotic vs. 150 Cases of Open Surgical Staging for Endometrial Cancer

Comparison between 150 Cases of Robotic vs. 150 Cases of Open Surgical Staging for Endometrial Cancer

Comparison of laparoscopic versus conventional open surgical staging procedure for endometrial cancer.

The aim of this study was to compare the surgical outcomes of laparoscopic surgery and conventional laparotomy for endometrial cancer. A total of 104 consecutive patients were non-randomly assigned to either laparoscopic surgery or laparotomy. All patients underwent comprehensive surgical staging procedures including total hysterectomy, bilateral salpingo-oophorectomy, and pelvic/para-aortic lymphadenectomy. The safety, morbidity, and survival rates of the two groups were compared, and the data was retrospectively analyzed. Thirty-four patients received laparoscopic surgery and 70 underwent laparotomy. Operation time for the laparoscopic procedure was 227.0+/-28.8 minutes, which showed significant difference from the 208.1+/-46.4 minutes (p=0.032) of the laparotomy group. The estimated blood loss of patients undergoing laparoscopic surgery was 230.3+/-92.4 mL. This was significantly less than that of the laparotomy group (301.9+/-156.3 mL, p=0.015). The laparoscopic group had an average of 20.8 pelvic and 9.1 para-aortic nodes retrieved, as compared to 17.2 pelvic and 8.5 para-aortic nodes retrieved in the laparotomy group. There was no significant difference (p=0.062, p=0.554). The mean hospitalization duration was significantly greater in the laparotomy group than the laparoscopic group (23.3 and 16.4 days, p<0.001). The incidence of postoperative complications was 15.7% and 11.8% in the laparotomy and laparoscopic groups respectively. No statistically significant difference was found between the two groups in the survival rate. Laparoscopic surgical staging operation is a safe and effective therapeutic procedure for management of endometrial cancer with an acceptable morbidity compared to the laparotomic approach, and is characterized by far less blood loss and shorter postoperative hospitalization.

Microlaparoscopy: A further development of minimally invasive surgery for endometrial cancer staging — Initial experience

Objectives To present our initial experience with micro-laparoscopy in the surgical treatment of endometrial cancer and to compare its outcomes with those of conventional laparoscopic approach. Methods Consecutive patients undergoing surgical staging of endometrial cancer using exclusively 3-mm working ports and a 3- or 5-mm laparoscope at the umbilicus (microlaparoscopy group; N = 23) were compared with historical controls selected from consecutive women who have had staging with conventional laparoscopy ( N = 80). Results No difference was found in demographics and preoperative variables between the two groups. Conversion from microlaparoscopy to a conventional laparoscopic technique occurred in two cases (9.7%), while there was no conversion to open surgical staging in either group. There were no significant differences between the microlaparoscopy group and the control group with regard to estimated blood loss [100 (10–400) vs. 100 (10–400), P = 0.09], number of pelvic lymph nodes (19.2 ± 7.4 vs. 18. 6 ± 7.2, P = 0.79), and complication rate (intraoperative: 0% vs. 2.5%, P = 1.0; postoperative: 8.7% vs. 13.7%, P = 0.73). Operative time was similar between groups when analysis was restricted to the last 20 conventional procedures performed period prior to beginning of the microlaparoscopy trial [155 (110–300) vs. 160 (115–295), P = 0.17]. The median length of hospital stay was 2 (1–10) days for women undergoing microlaparoscopic procedures compared to 3 (1–15) days for those undergoing conventional laparoscopy ( P = 0.001). Conclusions These preliminary results suggest that microlaparoscopy is a safe and adequate surgical option for endometrial cancer staging, with the potential to further decrease invasiveness of the conventional laparoscopic approach.

Oesophageal cancer staging using endoscopic ultrasonography.

Despite encouraging results from Europe and the USA, endoscopic ultrasonography has yet to become established in the UK for imaging gastrointestinal lesions. The aim of this prospective study was to investigate the accuracy of endoscopic ultrasonography for local tumour (T) and lymph node (N) staging of oesophageal cancer. Endoscopic ultrasonography was performed in 50 consecutive patients with operable oesophageal cancer. Its accuracy for locoregional tumour staging was assessed and a detailed analysis of the distribution of ultrasonographically detected lymph nodes performed. Endoscopic ultrasonography was highly accurate for both local tumour (92 per cent correct T stage prediction) and lymph node (86 per cent correct N stage prediction) staging compared with final histology. The procedure was also superior to open surgical staging performed by the surgeon; it had a tendency to overestimate malignant involvement of individual lymph nodes and had only limited ability to identify small benign lymph nodes, particularly in the abdomen. Endoscopic ultrasonography was reliable for both local tumour and lymph node staging of oesophageal cancer.