A Meta-analysis On The Effect Of Laparoscopy Versus Laparotomy Treatment Of Early Ovarian Cancer

Objective:The incidence of ovarian cancer accounts for 44.6% of gynecologic malignancies, the death rate ranks first in gynecological malignancies . Multiterm research results showed that the number of patients with ovarian cancer 5-year survival rate still hovers at about 30%. Due to the characteristics of ovarian cancer, it is difficult to be found at early stage , 70% patients is diagnosised at advanced stage. It has been paid more attention to the diagnosis and surgical treatment of the ovarian cancer at early stage. Laparotomy is the traditional surgery , the effect of the treatment has been approved by the numerous Gynecologic Oncologist. Laparoscopy is a minimally invasive procedure being rising up during last years. Laparoscopy is being widely used in examine and treatment of gynecological malignancy. Laparoscopy has characteristics such as slighter wound ,faster return of bowel movement. From 1992 laparoscopy overall staging surgery is been used in treatment of ovarian cancer,but the studies about the effect of laparoscopy versus laparotomy treatment of Early ovarian cancer are small sample clinical case-control studies , large sample clinical randomized control trial is still unachievable at the present time.This study base on pre-existing multiterm small sample clinical case-control studies compare with effect of laparoscopy versus laparotomy treatment of early ovarian epithelial cancer,expect reach a higher credibility conclusion ,In order to physicians choose the surgical treatment of early ovarian epithelial cancer provide a more reliable basis.Methods: Formulate strict selection and exclusion criteria,Retrieval Medline Pubmed, ScienceDirect, ProQuest, Ovid, CNKI, SciFinder,etc database. Using"ovarian canc* AND laparoscop*"for English Logical Search,or"早期卵巢癌腹腔镜手术"Chinese language search terms to search,using a free word search to Improve the recall rate. Retrieval language limit for English and Chinese. Collect clinical case-control studies published from 1995 to Mar 2010 which related effect of laparoscopy versus laparotomy treatment of early ovarian epithelial cancer. According to the selected and exclusion standard, 4 retrospective studies included in this study. Extract the content of the studies selected: experimental design , characteristics of the studies , results of the studies. Adopt RevMan 5.0.21 to compare the operating time ,estimated blood loss,pelvic lymph node dissection, para-aortic lymph node dissection,postoperative complications,hospital stay ,recurrence rate ,with the two surgical treatment.Results: 3 laparoscopic surgery and open surgery group the operating time of data heterogeneity ( Heterogeneity inspectionχ2= 23.18, P < 0.00001),OR combined adopts random effects model, OR=0.45, 95 % CI (-0.81 , 1.71 ). Test for overall effect: Z = 0.71, P = 0. 48. 2 laparoscopic surgery and open surgery group the blood loss of data heterogeneity (Heterogeneity inspectionχ2= 0.09, P = 0.76),OR combined adopts fixed effects model, OR=-0.77, 95 % CI (-1.19 , -0.36 ). Test for overall effect: Z = 1.30 , P = 0. 19. 2 laparoscopic surgery and open surgery group the Pelvic lymph node dissection of data heterogeneity(Heterogeneity inspectionχ2 = 1.33 , P = 0. 25),OR combined adopts fixed effects model, OR=-0.29, 95 % CI (-0.73 , 0.15). Test for overall effect: Z = 1.30 , P = 0. 19. 2 laparoscopic surgery and open surgery group the para-aortic lymph node dissection of data heterogeneity(Heterogeneity inspectionχ2 = 0.15 , P = 0. 70) OR combined adopts fixed effects model, OR=-0.22, 95 % CI (-0.65 , 0.22). Test for overall effect: Z = 0.98 , P = 0. 33. 3 laparoscopic surgery and open surgery group the postoperative complications of data heterogeneity(Heterogeneity inspectionχ2 = 0.13 , P = 0. 94) ,OR combined adopts fixed effects model, OR=0.17, 95 % CI (0.05 , 0.59). Test for overall effect: Z = 2.80 , P = 0. 005. 2 laparoscopic surgery and open surgery group the hospital stay of data heterogeneity(Heterogeneity inspectionχ2 = 0.57 , P = 0. 45),OR combined adopts fixed effects model, OR= -1.11, 95 % CI (-1.54 , -0.68). Test for overall effect: Z = 5.06 , P < 0. 00001. 2 laparoscopic surgery and open surgery group the recurrence rate of data heterogeneity(Heterogeneity inspectionχ2 = 0.46 , P = 0. 50),OR combined adopts fixed effects model, OR= 0.27, 95 % CI (0.07 , 1.04). Test for overall effect: Z = 1.90 , P = 0. 06.Conclusion: Laparoscopic surgery and open surgery for early ovarian cancer was not statistically significant effect of contrast in operating time,pelvic lymph node dissection,para-aortic lymph node dissection;The laparoscopy group had significantly less blood loss, and shorter postoperative hospital stay;laparoscopic surgery and open surgery for early ovarian cancer was not statistically significant effect of contrast in recurrence rate and death rate, authors consider that may be the follow-up time is too short, pending further follow-up observation. Above all, Laparotomy and laparoscopy showed similar surgical staging adequacy and accuracy, and laparoscopy showed more favorable operative outcomes. Laparoscopy was safe,feasible and accurate for early-stage ovarian cancer, although follow-up time was relatively short.