Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis.
To determine the efficacy, safety, and cost of laparoscopic surgery compared with laparotomy in women with ovarian tumors assumed to be benign. This study is a systematic review. We searched (MEDLINE, EMBASE, LILACS, and COCHRANE LIBRARY) trials registers and reference lists of published trial reports. Six randomized controlled trials were identified involving 324 patients. Duration of surgery, adverse effects of surgery, pain, length of hospital stay, and economic outcomes were compared. The mean duration of surgery was longer in the laparoscopy group overall (weighted mean difference 11.39, 95% CI 0.57-22.22). The pooled estimate for febrile morbidity decreased for laparoscopy (Peto OR 0.34, 95% CI 0.13-0.88). The odds of any adverse effect were decreased after laparoscopic procedures (Peto OR 0.26, 95% CI 0.12-0.55). The odds of being pain free were significantly greater for the laparoscopy group (Peto OR 7.35, 95% CI 4.3-12.56). Mean length of hospital stay was shorter in the laparoscopy group with reduction of 2.79 days (95% CI -2.95 to -2.62). In economic outcomes, there was a significant reduction of US$1045 (95% CI -1361 to -726.97) in the laparoscopy group. Laparoscopy is associated with a reduction in the following: febrile morbidity, urinary tract infection, postoperative complications, postoperative pain, days in hospital, and total cost. These findings should be interpreted with caution as only a small number of studies were identified including a total of only 324 women.
Medeiros
L R
LR
Postgraduate Program in Epidemiology: Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. lidia.rosi@terra.com.br
Stein
A T
AT
Fachel
J
J
Garry
R
R
Furness
S
S
D000368:Aged; D001707:Biopsy, Needle; D003362:Cost-Benefit Analysis; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D007813:Laparotomy / Q000191:economics / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods*; D010149:Postoperative Pain / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States