title: Laparoscopic and open abdominal staging for early-stage ovarian cancer: our experience, systematic review, and meta-analysis of comparative studies.
abstract: OBJECTIVE
  The aim of this study was to analyze perioperative and long-term survival outcomes after either laparoscopic or open abdominal staging for apparent early-stage ovarian cancer.
  
  
  METHODS
  Data of consecutive women with early-stage ovarian cancer undergoing comprehensive laparoscopic staging between 2003 and 2010 were matched with a historical cohort of patients undergoing open surgery. Five-year survival outcomes were analyzed using the Kaplan-Meier method. In addition, a systematic review of the literature and meta-analysis of comparative studies was performed
  
  
  RESULTS
  A total of 35 women undergoing staging via laparoscopy were compared with a cohort of 32 patients undergoing open surgery. Baseline characteristics were similar between groups. Spillage occurred in 6 and 4 patients in laparoscopic and open group, respectively (P = 0.59). Patients undergoing laparoscopy experienced longer operative time (P < 0.001), shorter hospital stay (P = 0.03), and lower postoperative complication rate (3% vs 28%; P = 0.005) than patients undergoing staging via open surgery. The median (range) follow-up period was 64 (37-106) and 100 (61-278) months for case and control, respectively (P < 0.001). Five-year disease-free survival (P = 0.12, log-rank test) and overall survival (P = 0.26, log-rank test) were not influenced by surgical approach. Pooled analyses of the literature results corroborate our results suggesting an improvement of perioperative results in the laparoscopic group in comparison with the open abdominal one. In comparison with open surgery, laparoscopy did not influenced spillage (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.35-1.73) and upstaging rate (OR, 0.7; 95% CI, 0.38-1.27). No between-group differences in survival were observed (OR, 0.5; 95% CI, 0.21-1.21).
  
  
  CONCLUSIONS
  Laparoscopy upholds open surgery in long-term oncologic control, reducing morbidity.
authors: *Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese; and †Department of Obstetrics and Gynecology, University of Bari, Bari, Italy.
authors: Giorgio
authors: G
authors: Bogani
authors: Antonella
authors: A
authors: Cromi
authors: Maurizio
authors: M
authors: Serati
authors: Edoardo
authors: E
authors: Di Naro
authors: Jvan
authors: J
authors: Casarin
authors: Ciro
authors: C
authors: Pinelli
authors: Fabio
authors: F
authors: Ghezzi
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D003949:Diagnostic Techniques, Surgical; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000473:pathology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies