目的:探讨微创手术(MIS)和常规腹部手术治疗上皮性卵巢癌(EOC)的疗效和安全性。按治疗类型分层。
方法:由日本妇科肿瘤协会卵巢癌委员会的专家小组进行系统评价和荟萃分析。几个学术数据库,包括PubMed/MEDLINE,Cochrane数据库,和Ichushi于2023年11月11日由日本医学图书馆协会搜索,使用关键词“上皮性卵巢癌”,“微创手术”,“腹腔镜”,和“机器人辅助”。两位作者独立评估了描述EOC的MIS治疗与传统腹部手术相比的文章。主要结果为生存和围手术期不良事件。
结果:在筛选1114项研究后,确定了35篇文章,包括早期EOCEOC的主要分期手术(PSS)(n=20)和间期切除手术(NACT-IDS;n=10)和晚期EOC的前期主要切除手术(PDS;n=5)后的新辅助化疗。这些研究包括29,888例患者(7661例接受MIS,22,227例接受腹部手术)。接受MIS和腹部手术的患者总生存期相似(PSS:比值比[OR]1.02,95%置信区间[CI]0.75-1.37;NACT-IDS:OR0.93,95CI0.25-3.44;PDS:OR0.66,95CI0.36-1.22,均P>0.05)。MIS显示围手术期并发症发生率与腹部手术相当(术中和术后,所有治疗类型P≥0.05)。然而,早期EOC(PSS:OR0.49,95CI0.26-0.91)和晚期EOC(NACT-IDS:OR0.2795CI0.16-0.44和PDS:OR0.27,95CI0.16-0.44)的淋巴结清扫率MIS低于腹部手术(P均<0.05)。
结论:与腹部手术相比,MIS对EOC患者的生存率和围手术期并发症没有负面影响。虽然管理信息系统是一个可行的选择,不同的病例选择和外科手术表明潜在的偏见,需要进一步的验证研究。
OBJECTIVE: To examine the efficacy and safety of minimally invasive surgery (MIS) and conventional abdominal surgery for epithelial ovarian cancer (EOC), stratified by treatment type.
METHODS: A systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Ovarian Cancer Committee. Several academic databases, including PubMed/MEDLINE, Cochrane Database, and Ichushi were searched by the Japan Medical Library Association on November 11, 2023, using the keywords \"epithelial ovarian cancer\", \"minimally invasive surgery\", \"laparoscopic\", and \"robot-assisted\". Articles describing MIS treatment for EOC compared with conventional abdominal surgery were independently assessed by two authors. The primary outcomes were survival and perioperative adverse events.
RESULTS: After screening 1114 studies, 35 articles were identified, including primary staging surgery (PSS) for early-stage EOC EOC (n = 20) and neoadjuvant chemotherapy following interval debulking surgery (NACT-IDS; n = 10) and upfront primary debulking surgery (PDS; n = 5) for advanced-stage EOC. These studies included 29,888 patients (7661 undergoing MIS and 22,227 undergoing abdominal surgery). Patients receiving MIS and abdominal surgery had similar overall survival (PSS: odds ratio [OR] 1.02, 95% confidence interval [CI] 0.75-1.37; NACT-IDS: OR 0.93, 95%CI 0.25-3.44 and PDS: OR 0.66, 95%CI 0.36-1.22, all P > 0.05). MIS showed perioperative complication rates comparable to those of abdominal surgery (intraoperative and postoperative, all treatment types P ≥ 0.05). However, the rate of lymph node dissection in early-stage EOC (PSS: OR 0.49, 95%CI0.26-0.91) and multivisceral resections in advanced-stage EOC (NACT-IDS: OR 0.27 95%CI 0.16-0.44 and PDS: OR 0.27, 95%CI 0.16-0.44) was lower in MIS than in abdominal surgery (all P < 0.05).
CONCLUSIONS: MIS did not negatively impact the survival and perioperative complications of patients with EOC compared to abdominal surgery. While MIS is a viable option, varied case selection and surgical procedures suggest potential bias, requiring further validation studies.