Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety

The aim of this study was to compare laparoscopic and laparotomic surgical staging in patients with stage I epithelial ovarian cancer in terms of feasibility and safety. A retrospective chart review was undertaken of all patients with apparent stage I epithelial ovarian cancer who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) surgical staging at the Center for Uterine Cancer, National Cancer Center, Korea, between January 2001 and August 2006. During the study period, 19 patients underwent laparotomic surgical staging and 17 patients underwent laparoscopic surgical staging. No cases were converted from laparoscopy to laparotomy. The two groups were similar in terms of age, body mass index, procedures performed, number of lymph nodes retrieved, and operating time. The laparoscopy group had less estimated blood loss (P= 0.001), faster return of bowel movement (P< 0.001), and a shorter postoperative hospital stay (P= 0.002) compared to the laparotomy group. Transfusions were required only in two laparotomy patients, and postoperative complications occurred only in four laparotomy patients. However, two patients with stage IA grade 1 and 2 disease in laparoscopy group had recurrence with one patient dying of disease. The accuracy and adequacy of laparoscopic surgical staging were comparable to laparotomic approach, and the surgical outcomes were more favorable than laparotomic approach. However, the oncologic safety of laparoscopic staging was not certain. This is the first report on the possible hazards of laparoscopic staging in early-stage ovarian cancer. In the absence of a large prospective trial, this technique should be performed cautiously.

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M333 PROGNOSTIC IMPACT OF HISTOLOGICAL TYPE IN STAGE I EPITHELIAL OVARIAN CANCER BASED ON COMPREHENSIVE SURGICAL STAGING

International Journal of Gynecology & Obstetrics ◽

10.1016/s0020-7292(12)61524-0 ◽

2012 ◽

Vol 119 ◽

pp. S638-S638

Author(s):

M. Mizuno ◽

H. Kajiyama ◽

K. Shibata ◽

S. Suzuki ◽

N. Yoshikawa ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Histological Type ◽

Stage I ◽

Surgical Staging ◽

Prognostic Impact

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Incidence of Lymph Node Metastases in Apparent Early-Stage Low-Grade Epithelial Ovarian Cancer: A Comprehensive Review

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000787 ◽

2016 ◽

Vol 26 (8) ◽

pp. 1407-1414 ◽

Cited By ~ 16

Author(s):

Victor Lago ◽

Lucas Minig ◽

Christina Fotopoulou

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Epithelial Ovarian Cancer ◽

Retrospective Studies ◽

Early Stage ◽

Stage I ◽

Surgical Staging ◽

Low Grade ◽

Early Stage Disease ◽

True Incidence

ObjectivesThis study aimed to determine the incidence of lymph node (LN) metastases in presumed stage I-II low-grade epithelial ovarian cancer (EOC).MethodsEligible studies were identified from MEDLINE and EMBASE (time frame, 2015–1975), that analyzed patients with clinical or radiologic presumed early-stage EOC who underwent a complete pelvic and para-aortic lymphadenectomy as part of their surgical staging. The number and site of dissected and involved LNs and the correlation with overall outcome are analyzed. The termlow gradeand also the older termwell differentiatedwere used.ResultsThirteen of 978 identified studies were selected, and 13 of 75 studies were identified as eligible. A total of 1403 patients were analyzed in these 13 retrospective studies. The final International Federation of Gynecology and Obstetrics staging after completed surgical staging was I to II in 912 patients (65%). A total of 338 patients (24%) had grade 1 tumors whereas 473 patients (34%) had grade 2, and 502 patients (36%) had grade 3 tumors. Systematic lymphadenectomy was performed in 1159 patients (83%), whereof 1142 (82%) were pelvic and para-aortic LN dissections.In 185 patients (13%), an upstaging from an apparent clinical stage I-II to IIIC occurred because of LN involvement: 64 (35%) of the patients had only pelvic LNs metastases, 69 (37%) had only para-aortic LNs metastasis, and 51 (28%) had both a pelvic and para-aortic LN involvement. When analyzing only the patients with low-grade (grade 1 as the old classification) presumed early-stage disease (n = 273), only 8 patients (2.9%; range, 0–6.2) were identified with LNs metastases present.ConclusionsThe incidence of occult LN metastases in apparent early-stage low-grade EOC is 2.9% in a metaanalysis of retrospective studies. Future larger-scale prospectively assessed studies with established surgical quality of the LN dissection are warranted to establish the true incidence of LN metastasis in presumed early low-grade disease.

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Laparoscopic staging for stage I epithelial ovarian cancer: Analysis of the National Cancer Data Base

Gynecologic Oncology ◽

10.1016/j.ygyno.2016.04.268 ◽

2016 ◽

Vol 141 ◽

pp. 97

Author(s):

A. Melamed ◽

J.T. Clemmer ◽

N.L. Keating ◽

J.D. Wright ◽

J.O. Schorge ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Data Base ◽

National Cancer Data Base ◽

Stage I ◽

Laparoscopic Staging ◽

Cancer Data

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Laparoscopic staging for apparent stage I epithelial ovarian cancer

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.08.030 ◽

2017 ◽

Vol 216 (1) ◽

pp. 50.e1-50.e12 ◽

Cited By ~ 19

Author(s):

Alexander Melamed ◽

Nancy L. Keating ◽

Joel T. Clemmer ◽

Amy J. Bregar ◽

Jason D. Wright ◽

...

Keyword(s):

Ovarian Cancer ◽

Epithelial Ovarian Cancer ◽

Stage I ◽

Laparoscopic Staging

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Platinum-based chemotherapy of high-risk stage I epithelial ovarian cancer following comprehensive surgical staging

International Journal of Gynecology & Obstetrics ◽

10.1016/0020-7292(94)90161-9 ◽

1994 ◽

Vol 45 (2) ◽

pp. 202-202

Author(s):

S.C. Rubin ◽

G.Y.C. Wong ◽

J.P. Curtin ◽

R.R. Barakat ◽

T.B. Hakes ◽

...

Keyword(s):

Ovarian Cancer ◽

High Risk ◽

Epithelial Ovarian Cancer ◽

Stage I ◽

Surgical Staging ◽

Platinum Based Chemotherapy

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A Comparative Study Between Laparoscopic Management of Ectopic Pregnancy and Laparotomy: Experience in Tertiary Care Hospital in Bangladesh: A Prospective Trial

Bangladesh Journal of Endosurgery ◽

10.3329/bje.v2i1.19570 ◽

2014 ◽

Vol 2 (1) ◽

pp. 1-4

Author(s):

Samsad Jahan ◽

Tripti Rani Das ◽

Samira Humaira Habib ◽

Akter Jahan ◽

Mahjabin Joarder ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Ectopic Pregnancy ◽

Prospective Trial ◽

Care Hospital ◽

Surgical Morbidity ◽

Laparoscopy Group ◽

Laparoscopic Management ◽

Estimated Blood Loss ◽

Laparotomy Group

Objectives: To compare the efficiency and surgical morbidity associated with laparoscopic management of tubal ectopic pregnancy (EP) compared with that of open laparotomy. Materials and methods: During November 2008 to October 2012, there were 89 with a confirmed ectopic pregnancy These patients were admitted through emergency or outpatient department and managed by laparoscopy (number 70) and by laparotomy (number 19). The diagnosis of ectopic pregnancy was based on history, clinical symptoms, physical examination, a positive serum B-human chorionic gonadotropin (B-HCG), transvaginal ultrasonography. Patients were informed pre-operatively about the surgical procedures. The main outcome measured included operative time, blood loss, and complications.Results: Laparoscopic surgery gives an overall success rate of 98.9%. Linear salpingostomy was the main procedure performed in both groups. Estimated blood loss was significantly lower in the laparoscopy group compared with laparotomy group (p<0.001). Only 3 (3.81%) patients in the laparoscopy group required blood transfusion, whereas 16 (74.94%) in the laparotomy group needed transfusion (P<0.0001). The duration of operation in laparoscopy group was 53.2 ± 16.8 minutes and 84.5 ± 30.3 minutes in the laparotomy group. The duration of hospitalization was significantly shorter in the laparoscopy group 1.12±0.5 days compared to 5.25±0.1days in the laparotomy group (p<0.0001). ). In the laparoscopy group 57(72.4%) patients did not need analgesia after surgery compared with laparotomy group where all the patients needed analgesia.Conclusion: Laparoscopic treatment (Salpingostomy or Salpingectomy) of EPs offers major benefits superior to laparotomy in terms of less blood loss, less need for blood transfusion and postoperative analgesia, a shorter duration of hospital stay. Laparoscopic management of ectopic pregnancy might be the most beneficial procedure with maximal safety and efficacy.

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Clinical Impact of Lymphadenectomy after Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Review of Available Data

Journal of Clinical Medicine ◽

10.3390/jcm10020334 ◽

2021 ◽

Vol 10 (2) ◽

pp. 334

Author(s):

Stephanie Seidler ◽

Meriem Koual ◽

Guillaume Achen ◽

Enrica Bentivegna ◽

Laure Fournier ◽

...

Keyword(s):

Ovarian Cancer ◽

Lymph Node ◽

Neoadjuvant Chemotherapy ◽

Epithelial Ovarian Cancer ◽

Lymph Node Dissection ◽

Prospective Trial ◽

Node Dissection ◽

Advanced Epithelial Ovarian Cancer ◽

The Impact ◽

Systematic Lymph Node Dissection

Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter.

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