title: Minimally Invasive Surgical Staging in Early-stage Ovarian Carcinoma: A Systematic Review and Meta-analysis.
abstract: Few studies investigated the efficacy and safety of minimally invasive surgery for the treatment of early-stage epithelial ovarian cancer (eEOC). In this context, we aimed to review the current evidence comparing laparoscopy and the laparotomic approach for staging procedures in eEOC. This systematic review was registered in the International Prospective Register of Systematic Reviews. Overall, 3065 patients were included: 1450 undergoing laparoscopy and 1615 undergoing laparotomic staging. Patients undergoing laparoscopy experienced a longer (but not statistically significant) operative time (weighted mean difference [WMD] = 28.3 minutes; 95% confidence interval [CI], -2.59 to 59.2), a lower estimated blood loss (WMD = -156.5 mL; 95% CI, -216.4 to -96.5), a shorter length of hospital stay (WMD = -3.7 days; 95% CI, -5.2 to -2.1), and a lower postoperative complication rate (odds ratio [OR] = 0.48; 95% CI, 0.29-0.81) than patients undergoing laparotomy. The upstaging (OR = 0.81; 95% CI, 0.55-1.20) and cyst rupture (OR = 1.32; 95% CI, 0.52-3.38) rates were similar between groups. Laparoscopic staging is associated with a shorter time to chemotherapy than laparotomic procedures (WMD = -5.16 days; 95% CI, -8.68 to -1.64). Survival outcomes were not influenced by the route of surgery. Pooled data suggested that the minimally invasive surgical approach is equivalent to laparotomy for the treatment of eEOC and may be superior in terms of perioperative outcomes. However, because of the low level of evidence of the included studies, further randomized trials are warranted.
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Obstetrics and Gynecology, Sant'Anna University Hospital, Ferrara, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Borghi
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Leone Roberti Maggiore
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiappa
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Carlos
authors.initials: C
authors.lastname: Lopez
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Sabatucci
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Cono
authors.initials: C
authors.lastname: Scaffa
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Alice
authors.initials: A
authors.lastname: Indini
authors.affiliation: Obstetrics and Gynecology, IRCCS AOU San Martino, Genoa, Italy; Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Ferrero
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy. Electronic address: domenica.lorusso@istitutotumori.mi.it.
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009367:Neoplasm Staging / Q000379:methods; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications
keywords: Laparoscopy; Open surgery; Outcome; Ovarian cancer; Staging