Comparison of the survival outcomes of laparoscopy versus laparotomy in treatment of early-stage ovarian cancer: a systematic review and meta-analysis

The minimally invasive resection of port-site metastasis of ovarian cancer after laparoscopy with cutaneous integrity: a case report and literature review

BACKGROUND

Postoperative wound recovery following laparotomy for port-site metastasis (PSM) resection is a concern. Reports indicate that wound healing disorders occur in patients with PSM. The challenges associated with PSM resection include the complete removal of the lesion, ensuring rapid wound healing, and maintaining the integrity of the abdominal wall. To date, there have been no reports on a minimally invasive approach for PSM resection following ovarian cancer through the inner side of the abdominal wall.

CASE PRESENTATION

A 66-year-old G2P1 patient with a history of high-grade serous ovarian adenocarcinoma IIA presented with two abdominal wall masses, suspected to be PSM. She underwent laparoscopic resection of the lesions under general anesthesia. The excised masses measured approximately 10 cm and 5 cm, and margins were negative. The surgery lasted 1 hour and 33 minutes, with minimal intraoperative bleeding and no complications. The postoperative recovery was smooth. No recurrence was observed during the 12-month follow-up.

CONCLUSIONS

In our view, laparoscopy may be used as a minimally invasive technique that allows for PSM in the abdominal wall.

Efficacy and safety of minimally invasive laparoscopic surgery under general anesthesia for ovarian cancer

BACKGROUND

Ovarian cancer is one of the most common malignant tumors in female reproductive system in the world, and the choice of its treatment is very important for the survival rate and prognosis of patients. Traditional open surgery is the main treatment for ovarian cancer, but it has the disadvantages of big trauma and slow recovery. With the continuous development of minimally invasive technology, minimally invasive laparoscopic surgery under general anesthesia has been gradually applied to the treatment of ovarian cancer because of its advantages of less trauma and quick recovery. However, the efficacy and safety of minimally invasive laparoscopic surgery under general anesthesia in the treatment of ovarian cancer are still controversial.

AIM

To explore the efficacy and safety of general anesthesia minimally invasive surgery in the treatment of ovarian cancer.

METHODS

The clinical data of 90 patients with early ovarian cancer in our hospital were analyzed retrospectively. According to the different surgical treatment methods, patients were divided into study group and control group (45 cases in each group). The study group received minimally invasive laparoscopic surgery under general anesthesia for ovarian cancer, while the control group received traditional open surgery for ovarian cancer. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), clinical efficacy and safety of the two groups were compared.

RESULTS

The intraoperative blood loss, length of hospital stay, postoperative gas evacuation time, and postoperative EORTC QLQ-C30 score of the study group were significantly better than those of the control group (P < 0.05). The incidence of postoperative complications in the study group was significantly lower than in the control group (P < 0.05). The two groups had no significant differences in the preoperative adrenocorticotropic hormone (ACTH), androstenedione (AD), cortisol (Cor), cluster of differentiation 3 positive (CD3+), and cluster of differentiation 4 positive (CD4+) indexes (P > 0.05). In contrast, postoperatively, the study group's ACTH, AD, and Cor indexes were lower, and the CD3+ and CD4+ indexes were higher than those in the control group (P < 0.05).

CONCLUSION

Minimally invasive laparoscopic surgery under general anesthesia in patients with early ovarian cancer can significantly improve the efficacy and safety, improve the short-term prognosis and quality of life of patients, and is worth popularizing.

Minimally Invasive Staging of Early-Stage Epithelial Ovarian Cancer versus Open Surgery in Terms of Feasibility and Safety: A Systematic Review and Meta-Analysis

Epithelial ovarian cancer is women's fourth most common oncological cause of death. One of the main prognostic factors in ovarian cancer is the tumor stage. For instance, surgical staging of the disease is focal when choosing the best therapeutic option for each case. Although open surgery is the prevalent approach for staging and treating ovarian cancer, the use of minimally invasive surgery (MIS) has found recent application in staging or restaging cases of early disease. Our work compares oncological outcomes after MIS staging for FIGO I epithelial ovarian cancer with the laparotomic approach. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations, we systematically searched the Pub Med and Scopus databases in February 2023. No temporal nor geographical limitation was made. We included the articles containing data about Disease-Free Survival (DFS) and Overall Survival (OS), Recurrence Rates (RR), and Upstaging Rates (UpR). We used comparative studies for the meta-analysis. After the database search and article selection, 19 works matched the inclusion criteria for the systematic review. Eleven of these were comparative studies between MIS and Open Surgical Staging (OSS) approaches for ovarian cancer staging and were included in the meta-analysis. The meta-analysis did not show a statistically significant difference between the MIS and the OSS group concerning DFS, OS, and RR. Only Upstaging Rate ≥ FIGO Stage II was statistically significative higher in the OSS group. Likewise, MIS is confirmed to be an approach with a lower profile of surgical complications. In conclusion, our study did not show one approach to be safer than the other. However, the lack of dedicated studies limits the evidence of our study. For instance, we recommend adequately selecting the specimen, minimizing the risk of spillage, and optimizing surgical staging.

Prognostic value and adverse events of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in primary advanced and platinum-sensitive recurrent epithelial ovarian cancer: a systematic review and meta-analysis

BACKGROUND

The original meta-analysis of hyperthermic intraperitoneal chemotherapy (HIPEC) is already outdated, owing to the latest trial results. This study aimed to clarify the efficacy and adverse events of cytoreductive surgery with HIPEC compared to conventional therapy for advanced and platinum-sensitive recurrent epithelial ovarian cancer (OC).

METHODS

In this meta-analysis, phase II/III controlled trials regarding 'HIPEC' and 'ovarian cancer' were searched for in electronic databases from inception to March 2022.

RESULTS

Twenty-one studies were included in the quantitative synthesis. The pooled hazard ratio [HR] in the HIPEC group for progression-free survival (PFS) (HR = 0.61, 95% confidence interval [CI]: 0.45-0.83, p = .002) and overall survival (OS) (HR = 0.65, 95% CI: 0.51-0.82, p < .001) were improved in the HIPEC group compared with the non-HIPEC group. For primary advanced disease, OS and PFS were significantly increased in patients receiving interval debulking surgery + HIPEC, whereas PFS was not significantly different between primary debulking surgery (PDS) + HIPEC and PDS alone. For platinum-sensitive recurrent disease, no correlation was observed for PFS and OS between the HIPEC and non-HIPEC groups (p < .05). The incidence of procedure-related complications was higher in the HIPEC group than in the non-HIPEC group (odds ratio = 1.93, 95% CI: 1.24-3.01, p < .01). The morbidity of leukopenia, neutropenia, nausea, hypoalbuminemia, and grades III-IV electrolyte disturbance was higher in the HIPEC group than in the non-HIPEC group. However, HIPEC administration reduced the risk of intra-abdominal bleeding and constipation.

CONCLUSION

HIPEC-based regimens improved the clinical prognosis for primary advanced OC, whereas no significant value was elicited for recurrent OC.

Robot-assisted laparoscopic staging compared to conventional laparoscopic staging and laparotomic staging in clinical early stage ovarian carcinoma

PURPOSE OF REVIEW

Robot-assisted laparoscopic staging (RALS) is increasingly used for staging epithelial ovarian cancer (EOC). Evidence of its safety is limited. The aim of this review is to compare the efficacy and safety of RALS in clinical early-stage EOC to conventional laparoscopy and laparotomy and to assess the level of evidence that is currently available to adopt this surgical technique.

RECENT FINDINGS

Only retrospective studies comparing staging by minimally invasive surgery (MIS) to laparotomy are available. Both RALS and conventional laparoscopic staging shorten length of hospital stay (LHS, mean -2.9 days) and decrease estimated blood loss (EBL, mean -79 ml less) compared to laparotomy. Complication rates and number of lymph nodes collected are similar in all surgical staging techniques. Survival outcomes after staging by MIS cannot be compared to staging by laparotomy because of the lack of evidence but RALS is probably noninferior to conventional laparoscopic staging.

SUMMARY

RALS probably improves perioperative outcomes in patients with clinical early stage EOC similar to conventional laparoscopic staging. Whether oncologic outcomes of RALS are comparable to open and conventional approaches is uncertain as there is only level C evidence and randomized controlled trials are urgently needed to confirm the current retrospective findings.

miRNA-612 suppresses ovarian cancer cell tumorigenicity by downregulating NOB1

MicroRNAs (miRNAs) play crucial roles in cancer progression. Our previous study demonstrated that NIN1/RPN12 binding protein 1 homolog (NOB1) was a functional regulator in the progression of ovarian cancer (OC). However, the role of miRNA-612 (miR-612) in OC has not been elucidated. In this study, we aimed to investigate the regulatory mechanism of NOB1 targeting miRNA, miR-612, in OC tumorigenicity. The miR-612 expression was down-regulated in OC patient tissues and four OC cell lines (Caov3, A2780, SKOV3 and OVCAR3). The miR-612 level was negatively correlated with NOB1 expression, and dual-luciferase reporter assay indicated that miR-612 suppressed NOB1 expression by targeting the 3'UTR of NOB1 transcript. Up-regulation of miR-612 mediated by lentiviral transduction suppressed cell proliferation, colony formation, migration, invasion, and induced apoptosis in OC cell lines. In addition, miR-612 overexpression inhibited tumor growth of OC in vivo by sequestering NOB1 expression. In conclusion, our results suggested that miR-612 directly targeted NOB1 to suppress OC progression. Therefore, the miR-612-NOB1 axis could serve as therapeutic targets for OC.

Comparison of Laparoscopic and Open Surgery for Women With Early-Stage Epithelial Ovarian Cancer

Objective

This study evaluated the oncologic outcomes of laparoscopy and laparotomy in the management of early-stage ovarian cancer patients.

Methods

We conducted an observational study of women diagnosed with International Federation of Gynecology and Obstetrics (FIGO) 2014 stage I ovarian cancer who underwent surgery at the West China Second University Hospital from 2012 to 2020. Patients who received adjuvant chemotherapy before surgery, those with non-epithelial histopathological types, or those with insufficient data were excluded. Using propensity score matching, data from consecutive laparoscopic patients treated by laparoscopy were matched 1:2 with a cohort of patients undergoing open surgery. The operative and survival outcomes among the matched cohorts were examined using the Kaplan–Meier method.

Results

Among 200 eligible patients, 74 patients undergoing laparoscopy were compared with a cohort of 126 patients undergoing open surgery. Baseline characteristics were similar between groups after matching. Patients who had laparoscopy had a shorter operative time (P = 0.001), a shorter hospital stay (P &lt;0.001), and lower blood loss (P = 0.001) than patients who had open surgery. The median (range) follow-up period was 43.0 (38.8–47.2) and 45.0 (36.0–54.0) months for cases and controls, respectively (P &lt;0.001). There are no significant differences in progression-free survival (P = 0.430, log-rank test) and overall survival (P = 0.067, log-rank test) between the two groups.

Conclusions

There is no difference in prognosis between laparoscopic and open surgery in women with stage I epithelial ovarian cancer. Laparoscopic treatment of early-stage ovarian cancer is safe and feasible for stage I epithelial ovarian cancer patients.

The Transumbilical Laparoendoscopic Single-Site Extraperitoneal Approach for Pelvic and Para-Aortic Lymphadenectomy: A Technique Note and Feasibility Study

Background

Nowadays, lymphadenectomy could be performed by the transperitoneal or extraperitoneal approach. Nevertheless, each approach has its own advantages and disadvantages. Under these circumstances, we developed a transumbilical laparoendoscopic single-site (TU-LESS) extraperitoneal approach for lymphadenectomy. In this research, the primary goal is to demonstrate the feasibility of the novel approach in systematic lymphadenectomy and present the surgical process step-by-step.

Methods

Between May 2020 and June 2021, patients who had the indications of systematic lymphadenectomy underwent lymphadenectomy via the TU-LESS extraperitoneal approach. This new approach was described in detail, and the clinical characteristics and surgical outcomes were collected and analyzed.

Results

Eight patients with gynecological carcinoma were included in the research, including four with high-risk endometrial cancer and four with early-stage ovarian cancer. The TU-LESS extraperitoneal approach for pelvic and para-aortic lymphadenectomy was successfully performed in all patients without conversion. In all, a median of 26.5 pelvic lymph nodes (range 18–35) and 18.0 para-aortic lymph nodes (range 7–43) were retrieved. There was a median of 166.5 min of surgical time (range 123–205). Patients had speedy recoveries without complications. All patients had positive pain responses after surgery, as well as satisfactory cosmetic and body image outcomes.

Conclusion

Our initial experience showed that it is feasible to perform systematic lymphadenectomy with the TU-LESS extraperitoneal approach. And this new approach may provide a new measure or a beneficial supplement for lymphadenectomy in gynecologic cancer.

Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review

Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.