title: Laparoscopic staging for apparent stage I epithelial ovarian cancer.
abstract: BACKGROUND
  Whereas advances in minimally invasive surgery have made laparoscopic staging technically feasible in stage I epithelial ovarian cancer, the practice remains controversial because of an absence of randomized trials and lack of high-quality observational studies demonstrating equivalent outcomes.
  
  
  OBJECTIVE
  This study seeks to evaluate the association of laparoscopic staging with survival among women with clinical stage I epithelial ovarian cancer.
  
  
  METHODS
  We used the National Cancer Data Base to identify all women who underwent surgical staging for clinical stage I epithelial ovarian cancer diagnosed from 2010 through 2012. The exposure of interest was planned surgical approach (laparoscopy vs laparotomy), and the primary outcome was overall survival. The primary analysis was based on an intention to treat: all women whose procedures were initiated laparoscopically were categorized as having had a planned laparoscopic procedure, regardless of subsequent conversion to laparotomy. We used propensity methods to match patients who underwent planned laparoscopic staging with similar patients who underwent planned laparotomy based on observed characteristics. We compared survival among the matched cohorts using the Kaplan-Meier method and Cox regression. We compared the extent of lymphadenectomy using the Wilcoxon rank-sum test.
  
  
  RESULTS
  Among 4798 eligible patients, 1112 (23.2%) underwent procedures that were initiated laparoscopically, of which 190 (17%) were converted to laparotomy. Women who underwent planned laparoscopy were more frequently white, privately insured, from wealthier ZIP codes, received care in community cancer centers, and had smaller tumors that were more frequently of serous and less often of mucinous histology than those who underwent staging via planned laparotomy. After propensity score matching, time to death did not differ between patients undergoing planned laparoscopic vs open staging (hazard ratio, 0.77, 95% confidence interval, 0.54-1.09; P = .13). Planned laparoscopic staging was associated with a slightly higher median lymph node count (14 vs 12, P = .005). Planned laparoscopic staging was not associated with time to death after adjustment for receipt of adjuvant chemotherapy, histological type and grade, and pathological stage (hazard ratio, 0.82, 95% confidence interval, 0.57-1.16).
  
  
  CONCLUSIONS
  Surgical staging via planned laparoscopy vs laparotomy was not associated with worse survival in women with apparent stage I epithelial ovarian cancer.
authors: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Alexander
authors: A
authors: Melamed
authors: Department of Health Care Policy, Harvard Medical School, and Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA.
authors: Nancy L
authors: NL
authors: Keating
authors: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Joel T
authors: JT
authors: Clemmer
authors: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Amy J
authors: AJ
authors: Bregar
authors: Departments of Obstetrics and Gynecology and Herbert Irving Comprehensive Cancer Center, Columbia University, and New York Presbyterian Hospital, New York, NY.
authors: Jason D
authors: JD
authors: Wright
authors: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: David M
authors: DM
authors: Boruta
authors: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: John O
authors: JO
authors: Schorge
authors: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Marcela G
authors: MG
authors: Del Carmen
authors: Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: jrauh-hain@partners.org.
authors: J Alejandro
authors: JA
authors: Rauh-Hain
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery*; D000077216:Carcinoma, Ovarian Epithelial; D017024:Chemotherapy, Adjuvant; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000473:pathology / Q000601:surgery*; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012111:Residence Characteristics / Q000706:statistics & numerical data; D015996:Survival Rate; D047368:Tumor Burden; D044465:White People
keywords: laparoscopy; laparotomy; ovarian cancer; staging