Minimally Invasive Surgery for the Management of Ovarian Cancer: A Systematic Review and Meta-analysis.

OBJECTIVE

To examine perioperative and survival outcomes of patients with ovarian cancer managed by minimally invasive surgery compared with laparotomy in the context of 1) early-stage epithelial ovarian cancer, 2) primary cytoreduction for advanced disease, and 3) interval debulking after neoadjuvant chemotherapy.

DATA SOURCES

A literature search was conducted PubMed, MEDLINE and ClinicalTrials.gov, Web of Science, Cochrane Library, and meeting abstract libraries (International Gynecological Cancer Society, Society of Gynecologic Oncology, American Society of Clinical Oncology) from 1994, the year of the first published laparoscopic clinical study in ovarian cancer, to May 2024. Studies that compared minimally invasive surgery with laparotomy for staging of ovarian cancer and reported perioperative or survival outcomes data were included. Single-arm studies, case studies, meeting abstracts, and studies involving borderline tumors, fertility-sparing surgery, or management of recurrent disease were excluded.

METHODS OF STUDY SELECTION

Three authors independently screened citations for relevance and inclusion and exclusion criteria and assessed the risk of bias of individual studies using the methodologic index for nonrandomized studies criteria for nonrandomized studies.

TABULTATION INTEGRATION AND RESULTS

From a total of 2,777 identified citations, 36 nonrandomized studies were included: 21 early-stage, five primary debulking for advanced stages, seven interval debulking after neoadjuvant chemotherapy, and three with heterogeneous populations. No randomized studies were identified. For early-stage cancer, nine studies found no difference in progression-free survival (risk ratio [RR] 1.05, 95% CI, 1.00-1.10, =34.7%, =.151), and 12 studies found no difference in overall survival (RR 1.00, 95% CI, 0.98-1.03, =49.7%, =.025). For primary debulking of advanced disease, rate of optimal debulking (five studies) (RR 1.11, 95% CI, 1.00-1.25, =41.5%, =.144) slightly favored minimally invasive techniques. For interval debulking, there was no difference in rates of optimal debulking (five studies) (RR 1.03, 95% CI, 0.96-1.11, =54.6%, <.051) between the two surgical modalities.

CONCLUSION

The inclusion of observational studies in this analysis with a fair amount of bias warrants caution in the interpretation of the findings. However, minimally invasive surgery may offer some perioperative advantages over laparotomy and may be an acceptable alternative for selected patients. For early-stage disease, there was no difference in survival outcomes between minimally invasive surgery and laparotomy. For those with advanced disease, rates of optimal debulking were similar.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42022359051.