Laparoscopy versus laparotomy for FIGO Stage I ovarian cancer.
BACKGROUND
Over the past ten years laparoscopy has become an increasingly common approach for the surgical removal of early stage ovarian tumours. There remains uncertainty about the value of this intervention. This review has been undertaken to assess the available evidence of the benefits and harms of laparoscopic surgery for the management of early stage ovarian cancer compared to laparotomy.


OBJECTIVE
To evaluate the benefits and harms of laparoscopy in the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic) when compared with laparotomy.


METHODS
Trials were identified by searching the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library Issue 2, 2007, MEDLINE (January 1990 to November 2007), EMBASE (1990 to November 2007), LILACS (1990 to November 2007), BIOLOGICAL ABSTRACTS (1990 to November 2007) and Cancerlit (1990 to November 2007). We also searched our own publication archives, based on prospective handsearching of relevant journals from November 2007. Reference lists of identified studies, gynaecological cancer handbooks and conference abstract were also scanned.


METHODS
Studies including patients with histologically proven stage I ovarian cancer according to the International Federation of Gynaecology and Obstetrics (FIGO).Studies comparing laparoscopic surgery with laparotomy for early stage ovarian cancer were only available from 1990. It was anticipated that a very small number of randomised controlled trials (RCTs) were conducted studying the management of early stage ovarian cancer. Therefore, non-randomised comparative studies, cohort studies and case-controls studies, but not studies with historical controls, were also considered.


METHODS
Data extraction was performed independently by five review authors (LRM, DDR, MIR, MCB and MIE) who assessed study quality and quality of extracted data. Extracted data included trial characteristics, characteristics of the study participants, interventions and outcomes. The quality of non RCTs was assessed using appropriate quality evaluations tools from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and from the Newcastle-Ottawa tool for observational studies (NOS).


RESULTS
No RCTs were identified. Three observational studies were identified.


CONCLUSIONS
This review has found no evidence to help quantify the value of laparoscopy for the management of early stage ovarian cancer as routine clinical practice.
Social Medicine/Epidemiology, Federal University of Rio Grande do Sul, Jose de Alencar 1244, 1009 Menino Deus, Porto Alegre, Rio Grande do Sul, Brazil, 90880-480. lidia.rosi@terra.com.br
Lídia R F
LR
Medeiros
Daniela D
DD
Rosa
Mary C
MC
Bozzetti
Maria Ines
MI
Rosa
Maria I
MI
Edelweiss
Airton T
AT
Stein
Alice
A
Zelmanowicz
Anaelena B
AB
Ethur
Roselaine R
RR
Zanini
D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*