To synthesize evidence from studies investigating survival outcomes for ovarian cancer patients undergoing minimally invasive surgery (traditional or robotic laparoscopy) compared with laparotomy.
We searched Ovid MEDLINE and Embase (inception to December 2019) METHODS OF STUDY SELECTION: Observational cohort studies and randomized controlled trials that compared risk of recurrence or death between women undergoing minimally invasive and open procedures for staging (10), interval cytoreduction (4), secondary cytoreduction (2), and evaluation of resectability (1) were included.
Data on the number of participants, number of deaths and recurrences, and results of analyses of overall or progression-free survival were abstracted for all studies. A random effects meta-analyses was used to pool results of studies comparing minimally invasive and open staging. Surgical approach (minimally invasive versus open) was not significantly associated with hazard of death or recurrence (pooled HR 0.92, 95% CI 0.61-1.38) or all-cause mortality (pooled HR 0.96, 95% CI 0.49-1.89). One randomized trial demonstrated that diagnostic laparoscopy can triage patients to neoadjuvant chemotherapy and avoid suboptimal primary surgery, without impacting recurrence-free or overall survival. Most studies included in this review were observational and at high risk for bias and few studies accounted for potential confounding.
Although existing studies do not demonstrate deleterious survival effects associated with minimally invasive surgery for ovarian cancer, these data must be viewed with caution given significant methodologic shortcomings in the existing literature.
Registered in PROSPERO (CRD42020191183).
Copyright © 2020. Published by Elsevier Inc.