新辅助化疗后晚期卵巢癌间隔减瘤手术的微创手术与开腹手术的疗效和安全性：一项系统评价和荟萃分析
Efficacy and Safety of Minimally Invasive Surgery Versus Open Laparotomy for Interval Debulking Surgery of Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A Systematic Review and A Meta-Analysis.
作者信息
Zeng Siyuan, Yu Yongai, Cui Yuemei, Liu Bing, Jin Xianyu, Li Zhengyan, Liu Lifeng
机构信息
Department of Obstetrics and Gynecology, Dalian Municipal Central Hospital, Dalian, China.
Dalian municipal Central Hospital, China Medical University, Shenyang, China.
出版信息
Front Oncol. 2022 Jul 18;12:900256. doi: 10.3389/fonc.2022.900256. eCollection 2022.
OBJECTIVE
The selection of minimally invasive surgery (MIS) or open laparotomy for ovarian cancer (OC) after neoadjuvant chemotherapy still remains controversial. This study aimed to assess the efficacy and safety of MIS versus open laparotomy following neoadjuvant chemotherapy for advanced OC, so as to provide another option to select optimal surgical procedures for patients with OC.
METHODS
Relevant literature studies about the risks of progression or mortality between women receiving MIS and open laparotomy for interval debulking surgery (IDS) were searched in the online databases, including PubMed, Embase, and the Cochrane Library with the following keywords: "ovarian neoplasms", "minimally invasive surgical procedures", "laparotomy", and "neoadjuvant therapy". Eligible studies were screened out for further meta-analysis.
RESULTS
Six eligible literature studies, with 643 patients in the MIS group and 2,885 patients in the open laparotomy group, were included in this meta-analysis. No significant differences were detected in the overall survival (OS) of patients with OC who were treated with MIS or open laparotomy [hazard ratio (HR) = 0.85; 95% confidence interval (CI) = 0.59-1.23; heterogeneity: P = 0.051, I = 57.6%]. However, the progression-free survival (PFS) was significantly higher in patients with OC treated with MIS than those treated with laparotomy (HR = 0.73; 95% CI = 0.57 to 0.92; heterogeneity: P = 0.276, I = 22.4%). The completeness of debulking removal (R0 rate) in the open laparotomy group was not statistically higher compared with the control group (RR = 1.07; 95% CI = 0.93 to 1.23; heterogeneity: P = 0.098, I = 52.3%), and no significant differences in residual disease of ≤1 cm (R1) (RR = 1.08; 95% CI = 0.91 to 1.28; heterogeneity: P = 0.330, I = 12.6%) and postoperative complications were found between the two groups (RR = 0.72; 95% CI = 0.34 to 1.54; heterogeneity: P = 0.055, I = 60.6%). Furthermore, the length of stays in hospital was significantly shorter in patients with OC treated with MIS than those treated with open laparotomy (Standard Mean Difference (SMD) = -1.21; 95% CI = -1.78 to -0.64; heterogeneity: P < 0.001, I = 92.7%].
CONCLUSIONS
For IDS after NACT in patients with advanced OC, complete cytoreductive surgery with MIS is another feasible and effective choice.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022298519, identifier CRD42022298519.
目的
新辅助化疗后，卵巢癌（OC）选择微创手术（MIS）还是开腹手术仍存在争议。本研究旨在评估新辅助化疗后MIS与开腹手术治疗晚期OC的疗效和安全性，以便为OC患者选择最佳手术方式提供另一种选择。
方法
在在线数据库（包括PubMed、Embase和Cochrane图书馆）中检索有关接受MIS和开腹手术进行中间减瘤手术（IDS）的女性疾病进展或死亡风险的相关文献研究，关键词如下：“卵巢肿瘤”、“微创手术”、“剖腹术”和“新辅助治疗”。筛选符合条件的研究进行进一步的荟萃分析。
结果
本荟萃分析纳入了6项符合条件的文献研究，MIS组643例患者，开腹手术组2885例患者。接受MIS或开腹手术治疗的OC患者的总生存期（OS）未发现显著差异[风险比（HR）=0.85；95%置信区间（CI）=0.59-1.23；异质性：P=0.051，I²=57.6%]。然而，接受MIS治疗的OC患者的无进展生存期（PFS）显著高于接受开腹手术治疗的患者（HR=0.73；95%CI=0.57至0.92；异质性：P=0.276，I²=22.4%）。开腹手术组的减瘤切除完整性（R0率）与对照组相比无统计学意义上的更高（RR=1.07；95%CI=0.93至1.23；异质性：P=0.098，I²=52.3%），两组间≤1cm残留病灶（R1）（RR=1.08；95%CI=0.91至1.28；异质性：P=0.330，I²=12.6%）和术后并发症无显著差异（RR=0.72；95%CI=0.34至1.54；异质性：P=0.055，I²=60.6%）。此外，接受MIS治疗的OC患者的住院时间显著短于接受开腹手术治疗的患者（标准化均数差（SMD）=-1.21；95%CI=-1.78至-0.64；异质性：P<0.001，I²=92.7%]。
结论
对于晚期OC患者新辅助化疗后的IDS，采用MIS进行完全细胞减灭术是另一种可行且有效的选择。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022298519，标识符CRD42022298519。
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