title: Impact of intraoperative rupture of the ovarian capsule on prognosis in patients with early-stage epithelial ovarian cancer: a meta-analysis.
abstract: BACKGROUND
  The impact of intraoperative rupture on prognosis is controversial in early-stage epithelial ovarian cancer (EOC). Thus, we performed a meta-analysis to determine its impact and to evaluate factors to increase its risk.
  
  
  METHODS
  We searched PubMed, Embase, and the Cochrane Library till May 2011, and 9 eligible studies including 2382 patients were evaluated. All patients were classified into three groups: no rupture; intraoperative rupture; preoperative involvement.
  
  
  RESULTS
  Preoperative involvement decreased progression-free survival when compared with intraoperative rupture (PFS; HR, 1.47; 95% CI, 1.01-2.14), which also showed poorer PFS than no rupture (HR, 2.41; 95% CI, 1.74-3.33). Although preoperative involvement reduced PFS when compared with intraoperative rupture (HR, 2.63; 95% CI, 1.11-6.20), there was no difference in it between intraoperative rupture and no rupture in patients who underwent complete surgical staging operation and adjuvant platinum-based chemotherapy if needed (HR, 1.49; 95% CI, 0.45-4.95). Furthermore, adhesion to adjacent tissues, grade 2 or 3 disease were more common (ORs, 2.01 and 2.47; 95% CIs, 1.20-3.37 and 1.12-5.46), whereas mucinous tumor was less frequent (OR, 0.51; 95% CI, 0.37-0.72) in intraoperative rupture than in no rupture.
  
  
  CONCLUSIONS
  Intraoperative rupture may not decrease PFS when compared with no rupture in patients with early-stage EOC who underwent complete surgical staging operation and adjuvant platinum-based chemotherapy. Furthermore, more adhesion to adjacent tissues and grade 2 or 3 disease, and less mucinous tumor are expected to increase the risk of intraoperative rupture.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University, College of Medicine, Seoul 110-744, Republic of Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Kim
authors.forename: J H
authors.initials: JH
authors.lastname: Ahn
authors.forename: H H
authors.initials: HH
authors.lastname: Chung
authors.forename: J W
authors.initials: JW
authors.lastname: Kim
authors.forename: N H
authors.initials: NH
authors.lastname: Park
authors.forename: Y S
authors.initials: YS
authors.lastname: Song
authors.forename: H P
authors.initials: HP
authors.lastname: Lee
authors.forename: Y B
authors.initials: YB
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D060787:Neoplasm Grading; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012307:Risk Factors; D012422:Rupture, Spontaneous