title: Survival impact of initial surgical approach in stage I ovarian cancer.
abstract: BACKGROUND
  The aim of this study was to evaluate the impact on survival of initial laparoscopic surgery compared with conventional laparotomy in stage I epithelial ovarian cancer.
  
  
  METHODS
  We conducted a retrospective study which enrolled all consecutive patients with stage I epithelial ovarian cancer between January 1984 and December 2006. Patients with a histological diagnosis of epithelial ovarian cancer who underwent laparoscopy were recruited if their cases were compatible with stage I (clinical or surgical) at initial exploration. The independent samples t test, chi-square test, log-rank and Cox proportional hazards model were performed.
  
  
  RESULTS
  A total of 208 patients were enrolled, including 34 patients with initial laparoscopy and 174 with laparotomy. The median follow-up time for survivors was 65 (range, 2-276) months. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 67.4% and 69.5% in the laparoscopy group, and 88.7% and 78.7% in the laparotomy group, respectively. The median time to recurrence was 14.5 (range, 2-67) months. In multivariate analysis, the initial laparoscopy approach posted significant adverse impacts on the OS (laparoscopy vs laparotomy, the hazard ratio [HR]: 3.52, p=0.009) and the RFS (laparoscopy vs laparotomy, HR: 2.58, p=0.024), while a higher substage (stage IB-IC vs IA, HR: 8.29, p=0.040) was associated with only a worse OS, and its impact on the RFS was marginal.
  
  
  CONCLUSIONS
  An initial laparoscopy intervention and higher substage posted significant adverse effects on the prognosis in stage I epithelial ovarian cancer. Important precautions when using laparoscopy for adnexal masses, such as avoiding rupture, applying protection, and submitting frozen sections, are recommended.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Tzu-I
authors.initials: TI
authors.lastname: Wu
authors.forename: Chyi-Long
authors.initials: CL
authors.lastname: Lee
authors.forename: Pei-Ju
authors.initials: PJ
authors.lastname: Liao
authors.forename: Kuan-Gen
authors.initials: KG
authors.lastname: Huang
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Chang
authors.forename: Hung-Hsueh
authors.initials: HH
authors.lastname: Chou
authors.forename: Chin-Jung
authors.initials: CJ
authors.lastname: Wang
authors.forename: Yung-Kuei
authors.initials: YK
authors.lastname: Soong
authors.forename: Swei
authors.initials: S
authors.lastname: Hsueh
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies