Cardenas-Goicoechea Joel, Wang Yu, McGorray Susan, Saleem Mohammed D, Carbajal Mamani Semiramis L, Pomputius Ariel F, Markham Merry-Jennifer, Castagno Jacqueline C
Division Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Florida College of Medicine, P.O. Box 100294, Gainesville, FL, 32610, USA.
Department of Biostatistics, University of Florida College of Medicine, Gainesville, FL, USA.
J Robot Surg. 2019 Feb;13(1):23-33. doi: 10.1007/s11701-018-0838-x. Epub 2018 Jul 10.
The introduction of minimally invasive surgery in other gynecologic cancers has shown benefits with similar oncologic outcomes. However, the biology and complexity of surgery for ovarian cancer may preclude this approach for ovarian cancer patients. Our objective is to assess feasibility to achieve complete cytoreductive surgery after neoadjuvant chemotherapy for stage IIIC-IV ovarian cancer patients via minimally invasive surgery. Our data sources include PubMed, Embase, Scopus, Biosis, Clinicaltrials.gov, and the Cochrane Library. Meta-analysis was performed using the random-effects model with DerSimonian and Laird estimator for the amount of heterogeneity to estimate the pooled outcomes. A funnel plot and Egger's regression test were used to test publication bias. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the studies. There were 6 studies (3 prospective, 3 retrospective) that met the criteria for meta-analysis with a total of 3231 patients, 567 were in the minimally invasive group and 2664 in the laparotomy group. Both groups were similar in stage and serous histology. Complete cytoreductive surgery was achieved in 74.50% (95% CI 40.41-97.65%) and 53.10% (95% CI 4.88-97.75%) of patients in the minimally invasive and laparotomy groups, respectively. There was no statistical significant difference between these 2 pooled proportions (p = 0.52). Three studies compared minimally invasive surgery vs laparotomy. No significant difference was observed between the 2 groups in obtaining complete cytoreductive surgery [OR = 0.90 (95% CI 0.70-1.16; p = 0.43)]. A symmetrical funnel plot indicated no publication bias. The pooled proportion for grade > 2 postoperative complications was not significant among the laparoscopy group [3.11% (95% CI 0.00-10.24%; p = 0.15)]. Complete cytoreductive surgery appears feasible and safe with minimally invasive surgery in selected advanced ovarian cancer patients after neoadjuvant chemotherapy.
在其他妇科癌症中引入微创手术已显示出益处，且肿瘤学结局相似。然而，卵巢癌手术的生物学特性和复杂性可能使这种方法不适用于卵巢癌患者。我们的目标是评估对于IIIC-IV期卵巢癌患者，在新辅助化疗后通过微创手术实现完全细胞减灭术的可行性。我们的数据来源包括PubMed、Embase、Scopus、Biosis、Clinicaltrials.gov和Cochrane图书馆。采用随机效应模型和DerSimonian与Laird估计量进行荟萃分析，以估计异质性量并汇总结果。使用漏斗图和Egger回归检验来检验发表偏倚。采用纽卡斯尔-渥太华质量评估量表来评估研究质量。有6项研究（3项前瞻性研究、3项回顾性研究）符合荟萃分析标准，共纳入3231例患者，其中567例在微创手术组，2664例在开腹手术组。两组在分期和浆液性组织学方面相似。微创手术组和开腹手术组分别有74.50%（95%CI 40.41 - 97.65%）和53.10%（95%CI 4.88 - 97.75%）的患者实现了完全细胞减灭术。这两个汇总比例之间无统计学显著差异（p = 0.52）。三项研究比较了微创手术与开腹手术。两组在实现完全细胞减灭术方面未观察到显著差异[OR = 0.90（95%CI 0.70 - 1.16；p = 0.43）]。对称的漏斗图表明无发表偏倚。腹腔镜组术后>2级并发症的汇总比例不显著[3.11%（95%CI 0.00 - 10.24%；p = 0.15）]。对于部分经过新辅助化疗的晚期卵巢癌患者，微创手术实现完全细胞减灭术似乎是可行且安全的。
