Laparoscopy may offer advantages to laparotomy for some women with ovarian cancer

Key takeaways:

• Laparoscopy may have some advantages over laparotomy for ovarian cancer.
• Results of this review are limited and randomized controlled trials are needed for oncologic outcomes of laparoscopy vs. laparotomy.

Laparoscopy may offer perioperative advantages to laparotomy and may be an acceptable alternative for some women with ovarian cancer, but systematic review and meta-analysis findings are limited by inclusion of only observational studies.

“To date, the feasibility and safety of laparoscopy have been demonstrated only in observational studies,” Farr R. Nezhat, MD, adjunct professor in the department of obstetrics and gynecology at the New York University Grossman Long Island School of Medicine, and colleagues wrote in O&G Open. “No randomized controlled clinical trials have compared the perioperative and survival outcomes of patients with ovarian cancer undergoing laparoscopy with the outcomes of those undergoing laparotomy.”

Nezhat and colleagues conducted a literature search from 1994 to May 2024 and identified 36 nonrandomized studies comparing minimally invasive surgery with laparotomy for staging of ovarian cancer. All studied reported perioperative or survival outcomes. Overall, 21 studies assessed early-stage, five primary debulking for advanced stages, seven interval debulking after neoadjuvant chemotherapy and three had heterogenous populations with ovarian cancer.

Nine studies demonstrated no difference in progression-free and 12 demonstrated no difference in overall survival for early-stage ovarian cancer. Five studies demonstrated no difference in optimal debulking rates or complete gross cytoreduction for interval debulking between laparoscopy and laparotomy.

In addition, five studies demonstrated slight favoring for minimally invasive surgery vs. laparotomy for optimal debulking rates (RR = 1.11; 95% CI, 1-1.25) and complete gross cytoreduction (RR = 1.15; 95% CI, 1.04-1.29) for primary debulking of advanced disease.

According to the researchers, the results of this review are limited due to inclusion of only observational studies, but an ongoing prospective randomized controlled trial, the LANCE trial, may bring “new insight” into oncologic outcomes with laparoscopy vs. laparotomy for ovarian cancer.

“Our comprehensive review and analysis of the current literature shows that minimally invasive surgery is feasible in the treatment of both early and advanced ovarian cancers,” the researchers wrote. “Moreover, the analysis suggests that minimally invasive surgery is associated with a significant reduction in blood loss and a shorter hospital stay than laparotomy.”