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Abstract
Introduction/Background While open laparotomy (LPT) at primary debulking surgery is still the standard of care for patients with advanced ovarian cancer it remains unclear, whether minimally invasive surgery (MIS) might be a safe alternative after neoadjuvant chemotherapy.
This systematic review and meta-analysis investigates the oncological safety and outcomes of open versus laparoscopic interval debulking surgery (IDS) in patients with ovarian cancer.
Methodology Ovid/Medline, Pubmed and Cochrane databases were systematically screened for eligible studies investigating at least one primary outcome (surgical resection status or patient survival) after LPT compared to MIS IDS for FIGO stage III-IV ovarian cancer. IBM® SPSS was used for statistical analysis.
Results Out of 76 studies screened, 16 trials published between 2015 and 2023 with a total of 8591 patients (3087 MIS, 5504 LPT) were included in this study.
A complete cytoreduction to no visible tumor (R0) was achieved significantly more often after MIS compared to LPT (RR = 1.15; 95% CI = 1.03 to 1.27; p = 0.01; Heterogeneity I2 = 74%). There were no significant differences of overall survival (HR = 0.86; 95% CI = 0.61 to 1.11) or progression-free survival (HR = 0.8; 95% CI = 0.44 to 1.17) between the two groups.
Patients undergoing MIS experienced significantly fewer postoperative complications (RR = 0.54; 95% CI = 0.36 to 0.81; p = 0.00, Heterogeneity I2 = 53%). Laparoscopic IDS was further associated with a lower mean blood loss (MIS 182.62ml, LPT 382.52ml), a shorter mean hospital stay (MIS 3.38, LPT 5.98 days) and a faster mean initiation of adjuvant chemotherapy (MIS 27.67, LPT 32.73 days).
Conclusion This study indicates that laparoscopic IDS is an oncologically safe alternative in selected patients with advanced-stage ovarian cancer. However, prospective randomised controlled trials should confirm these findings and clinical and molecular markers identifying patients who will benefit from MIS are needed.
Disclosures None.
