Effect of Laparoscopy versus Laparotomy on Recurrence for Borderline Ovarian Tumors: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 WUCai-liang ¹ , BIXue-han ² , WEIMin ² , GELong ³ ,  YANGYong-xiu ²

1. The First Clinical Medical College of Lanzhou University, Lanzhou 730000, China;
2. The First Hospital of Lanzhou University, Lanzhou 730000, China;
3. Evidence-based Medicine Center, Lanzhou University, Lanzhou 730000, China;

Corresponding author：

YANGYong-xiu, Email: yongxiuyang@163.com

Keywords：

Borderline ovarian tumor; Laparoscopy; Laparotomy; Recurrence; Systematic review; Meta-analysis; Cohort study

DOI：

10.7507/1672-2531.20160141

Video：

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Objective To systematically review the effect of laparoscopy versus laparotomy for borderline ovarian tumors (BOTs) on postoperative recurrence. Methods We searched PubMed, The Cochrane Library (Issue 11, 2015), EMbase, Web of Science, CNKI, WanFang Data and CBM databases from inception to Nov. 2015, to collect relevant clinical studies comparing laparoscopy and laparotomy for BOTs. Two reviewer independently screened literature, extracted data and assessed the risk of bias of include studies by using NOS scale. Then, meta-analysis was performed by using RevMan 5.3 software. Results Nineteen cohort studies were included. The scores of NOS scale showed that 10 studies were < 7 points, while the other 9 studies were≥7 points. The results of meta-analysis showed that: the recurrence rate of tumor (OR=1.75, 95%CI 1.05 to 2.91, P=0.03) in the laparoscopy group was higher than that in the laparotomy group, but no significant differences were found in further subgroup analysis according to type of operations (conservative surgery: OR=1.22, 95%CI 0.71 to 2.08, P=0.47; non-conservative surgery: OR=4.38, 95% CI 0.85 to 22.68, P=0.08). The diameter of tumor in the laparoscopy group was significant smaller than that in the laparotomy group (MD=-6.88, 95% CI-8.15 to-5.61, P < 0.000 01), and the rate of rupture of tumor in the laparoscopy group was significant higher than that in the laparotomy group (OR=3.99, 95% CI 2.54 to 6.26, P < 0.000 01). Conclusion Current evidence shows, compared with laparotomy, laparoscopy has similar effect on postoperative recurrence and smaller diameter of tumor, but laparoscopy could increase the rate of rupture of tumor. Due to the limited quality and sample size of included studies, more high quality and large sample size studies are need to prove the above conclusion.

Citation： WUCai-liang, BIXue-han, WEIMin, GELong, YANGYong-xiu. Effect of Laparoscopy versus Laparotomy on Recurrence for Borderline Ovarian Tumors: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(8): 913-919. doi: 10.7507/1672-2531.20160141 Copy

1.	Yahata T, Banzai C, Tanaka K. Histology-specific long-term trends in the incidence of ovarian cancer and borderline tumor in Japanese females:a population-based study from 1983 to 2007 in Niigata. J Obstet Gynaecol Res, 2012, 38(4):645-650.
2.	Morotti M, Menada MV, Gillott DJ, et al. The preoperative diagnosis of borderline ovarian tumors:a review of current literature. Arch Gynecol Obstet, 2012, 285(4):1103-1112.
3.	Burger CW, Prinssen HM, Baak JP, et al. The management of borderline epithelial tumors of the ovary. Int J Gynecol Cancer, 2000, 10(3):181-197.
4.	Basaran D, Salman MC, Calis P, et al. Diagnostic accuracy of intraoperative consultation (frozen section) in borderline ovarian tumours and factors associated with misdiagnosis. J Obstet Gynaecol, 2014, 34(5):429-434.
5.	Heintz AP, Odicino F, Maisonneuve P, et al. Carcinoma of the ovary. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet, 2006, 95 Suppl 1:S161-192.
6.	Wong HF, Low JJ, Chua Y, et al. Ovarian tumors of borderline malignancy:a review of 247 patients from 1991 to 2004. Int J Gynecol Cancer, 2007, 17(2):342-349.
7.	Morice P, Denschlag D, Rodolakis A, et al. Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer, 2011, 21(5):951-963.
8.	Seong SJ, Kim da H, Kim MK, et al. Controversies in borderline ovarian tumors. J Gynecol Oncol, 2015, 26(4):343-349.
9.	Shim SH, Kim SN, Jung PS, et al. Impact of surgical staging on prognosis in patients with borderline ovarian tumours:A metaanalysis. Eur J Cancer, 2016, 54:84-95.
10.	Trimble CL, Kosary C, Trimble EL. Long-term survival and patterns of care in women with ovarian tumors of low malignant potential. Gynecol Oncol, 2002, 86(1):34-37.
11.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:http://www.cochranehandbook.org.
12.	GA Wells SB, O. C. D. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp, [March2016].
13.	Hayley AC, Downey LA, Shiferaw B, et al. Amphetamine-type stimulant use and the risk of injury or death as a result of a roadtraffic accident:A systematic review of observational studies. Eur Neuropsychopharmacol, 2016, 26(6):901-922.
14.	陶陶, 曹冬焱, 杨佳欣, 等.卵巢交界性上皮性肿瘤复发相关因素及术后生育状况的分析.中华医学杂志, 2010, 90(19):1304-1308.
15.	陶陶, 曹冬焱, 杨佳欣, 等.交界性卵巢上皮性肿瘤保守性手术的预后与生育状况.中国医学科学院学报, 2010, 32(5):488-492.
16.	戴伟超.交界性卵巢肿瘤89例临床和病理特征及复发相关因素、术后生育状况的分析.福建医科大学, 2013.
17.	高彩霞. 40岁以下卵巢上皮性交界性肿瘤患者保留生育功能63例临床分析.大连医科大学, 2012.
18.	高峻, 曲立兵.卵巢交界性肿瘤的诊断与治疗.内蒙古医学院学报, 2011, (3):249-252.
19.	华晓萍. 231例卵巢交界性浆液性肿瘤的临床病例分析.浙江大学, 2015.
20.	李青, 赵卫东, 程敏, 等. 124例卵巢交界性肿瘤的临床分析.安徽医科大学学报, 2012, (11):1361-1364.
21.	刘玉蕾.腹腔镜手术处理卵巢交界性肿瘤的预后分析.河南科技大学学报(医学版), 2011, (1):38-39.
22.	秦聪颖.卵巢交界性肿瘤临床病理特征及预后相关分析.河北医科大学, 2015.
23.	任婕, 楼江燕, 刘辉, 等.交界性卵巢上皮性肿瘤234例临床病理及预后分析.中华妇产科杂志, 2009, 44(2):116-120.
24.	沈红雁.卵巢交界性肿瘤的临床特征及其预后相关因素研究.安徽医科大学, 2012.
25.	Romagnolo C, Gadducci A, Sartori E, et al. Management of borderline ovarian tumors:results of an Italian multicenter study. Gynecol Oncol, 2006, 101(2):255-260.
26.	Wu TI, Lee CL, Wu MY, et al. Prognostic factors predicting recurrence in borderline ovarian tumors. Gynecol Oncol, 2009, 114(2):237-241.
27.	Maneo A, Vignali M, Chiari S, et al. Are borderline tumors of the ovary safely treated by laparoscopy? Gynecol Oncol, 2004, 94(2):387-392.
28.	Desfeux P, Camatte S, Chatellier G, et al. Impact of surgical approach on the management of macroscopic early ovarian borderline tumors. Gynecol Oncol, 2005, 98(3):390-395.
29.	Fauvet R, Boccara J, Dufournet C, et al. Laparoscopic management of borderline ovarian tumors:results of a French multicenter study. Ann Oncol, 2005, 16(3):403-410.
30.	Ødegaard E, Staff AC, Langebrekke A, et al. Surgery of borderline tumors of the ovary:retrospective comparison of short-term outcome after laparoscopy or laparotomy. Acta Obstet Gynecol Scand, 2007, 86(5):620-626.
31.	Trillsch F, Ruetzel JD, Herwig U, et al. Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT). J Ovarian Res, 2013, 6(1):48.
32.	刘晓琳.交界性卵巢肿瘤的临床分析.当代医学, 2014, 20(1):58-59.
33.	Furukawa N, Nishioka K, Noguchi T, et al. Port-site metastasis of mucinous borderline ovarian tumor after laparoscopy. Case Rep Oncol, 2014, 7(3):804-809.
34.	Berretta R, Rolla M, Patrelli TS, et al. Incidence of port-site metastasis after laparoscopic management of borderline ovarian tumors:a series of 22 patients. Eur J Gynaecol Oncol, 2009, 30(3): 300-302.
35.	Sobiczewski P, Kupryjanczyk J, Michalski W, et al. The Evaluation of Risk Factors Associated With Relapse and Recurrence of Borderline Ovarian Tumors With Long-Term Follow-up. Int J Gynecol Cancer, 2016, 26(6):1053-1061.
36.	Uzan C, Nikpayam M, Ribassin-Majed L, et al. Influence of histological subtypes on the risk of an invasive recurrence in a large series of stage I borderline ovarian tumor including 191 conservative treatments. Ann Oncol, 2014, 25(7):1312-1319.
37.	Black JD, Altwerger GH, Ratner E, et al. Management of Borderline Ovarian Tumors Based on Patient and Tumor Characteristics. Gynecol Obstet Invest, 2015 Jun 6.[Epub ahead of print].

1. Yahata T, Banzai C, Tanaka K. Histology-specific long-term trends in the incidence of ovarian cancer and borderline tumor in Japanese females:a population-based study from 1983 to 2007 in Niigata. J Obstet Gynaecol Res, 2012, 38(4):645-650.
2. Morotti M, Menada MV, Gillott DJ, et al. The preoperative diagnosis of borderline ovarian tumors:a review of current literature. Arch Gynecol Obstet, 2012, 285(4):1103-1112.
3. Burger CW, Prinssen HM, Baak JP, et al. The management of borderline epithelial tumors of the ovary. Int J Gynecol Cancer, 2000, 10(3):181-197.
4. Basaran D, Salman MC, Calis P, et al. Diagnostic accuracy of intraoperative consultation (frozen section) in borderline ovarian tumours and factors associated with misdiagnosis. J Obstet Gynaecol, 2014, 34(5):429-434.
5. Heintz AP, Odicino F, Maisonneuve P, et al. Carcinoma of the ovary. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet, 2006, 95 Suppl 1:S161-192.
6. Wong HF, Low JJ, Chua Y, et al. Ovarian tumors of borderline malignancy:a review of 247 patients from 1991 to 2004. Int J Gynecol Cancer, 2007, 17(2):342-349.
7. Morice P, Denschlag D, Rodolakis A, et al. Recommendations of the Fertility Task Force of the European Society of Gynecologic Oncology about the conservative management of ovarian malignant tumors. Int J Gynecol Cancer, 2011, 21(5):951-963.
8. Seong SJ, Kim da H, Kim MK, et al. Controversies in borderline ovarian tumors. J Gynecol Oncol, 2015, 26(4):343-349.
9. Shim SH, Kim SN, Jung PS, et al. Impact of surgical staging on prognosis in patients with borderline ovarian tumours:A metaanalysis. Eur J Cancer, 2016, 54:84-95.
10. Trimble CL, Kosary C, Trimble EL. Long-term survival and patterns of care in women with ovarian tumors of low malignant potential. Gynecol Oncol, 2002, 86(1):34-37.
11. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:http://www.cochranehandbook.org.
12. GA Wells SB, O. C. D. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses, Available at:http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp, [March2016].
13. Hayley AC, Downey LA, Shiferaw B, et al. Amphetamine-type stimulant use and the risk of injury or death as a result of a roadtraffic accident:A systematic review of observational studies. Eur Neuropsychopharmacol, 2016, 26(6):901-922.
14. 陶陶, 曹冬焱, 杨佳欣, 等.卵巢交界性上皮性肿瘤复发相关因素及术后生育状况的分析.中华医学杂志, 2010, 90(19):1304-1308.
15. 陶陶, 曹冬焱, 杨佳欣, 等.交界性卵巢上皮性肿瘤保守性手术的预后与生育状况.中国医学科学院学报, 2010, 32(5):488-492.
16. 戴伟超.交界性卵巢肿瘤89例临床和病理特征及复发相关因素、术后生育状况的分析.福建医科大学, 2013.
17. 高彩霞. 40岁以下卵巢上皮性交界性肿瘤患者保留生育功能63例临床分析.大连医科大学, 2012.
18. 高峻, 曲立兵.卵巢交界性肿瘤的诊断与治疗.内蒙古医学院学报, 2011, (3):249-252.
19. 华晓萍. 231例卵巢交界性浆液性肿瘤的临床病例分析.浙江大学, 2015.
20. 李青, 赵卫东, 程敏, 等. 124例卵巢交界性肿瘤的临床分析.安徽医科大学学报, 2012, (11):1361-1364.
21. 刘玉蕾.腹腔镜手术处理卵巢交界性肿瘤的预后分析.河南科技大学学报(医学版), 2011, (1):38-39.
22. 秦聪颖.卵巢交界性肿瘤临床病理特征及预后相关分析.河北医科大学, 2015.
23. 任婕, 楼江燕, 刘辉, 等.交界性卵巢上皮性肿瘤234例临床病理及预后分析.中华妇产科杂志, 2009, 44(2):116-120.
24. 沈红雁.卵巢交界性肿瘤的临床特征及其预后相关因素研究.安徽医科大学, 2012.
25. Romagnolo C, Gadducci A, Sartori E, et al. Management of borderline ovarian tumors:results of an Italian multicenter study. Gynecol Oncol, 2006, 101(2):255-260.
26. Wu TI, Lee CL, Wu MY, et al. Prognostic factors predicting recurrence in borderline ovarian tumors. Gynecol Oncol, 2009, 114(2):237-241.
27. Maneo A, Vignali M, Chiari S, et al. Are borderline tumors of the ovary safely treated by laparoscopy? Gynecol Oncol, 2004, 94(2):387-392.
28. Desfeux P, Camatte S, Chatellier G, et al. Impact of surgical approach on the management of macroscopic early ovarian borderline tumors. Gynecol Oncol, 2005, 98(3):390-395.
29. Fauvet R, Boccara J, Dufournet C, et al. Laparoscopic management of borderline ovarian tumors:results of a French multicenter study. Ann Oncol, 2005, 16(3):403-410.
30. Ødegaard E, Staff AC, Langebrekke A, et al. Surgery of borderline tumors of the ovary:retrospective comparison of short-term outcome after laparoscopy or laparotomy. Acta Obstet Gynecol Scand, 2007, 86(5):620-626.
31. Trillsch F, Ruetzel JD, Herwig U, et al. Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT). J Ovarian Res, 2013, 6(1):48.
32. 刘晓琳.交界性卵巢肿瘤的临床分析.当代医学, 2014, 20(1):58-59.
33. Furukawa N, Nishioka K, Noguchi T, et al. Port-site metastasis of mucinous borderline ovarian tumor after laparoscopy. Case Rep Oncol, 2014, 7(3):804-809.
34. Berretta R, Rolla M, Patrelli TS, et al. Incidence of port-site metastasis after laparoscopic management of borderline ovarian tumors:a series of 22 patients. Eur J Gynaecol Oncol, 2009, 30(3): 300-302.
35. Sobiczewski P, Kupryjanczyk J, Michalski W, et al. The Evaluation of Risk Factors Associated With Relapse and Recurrence of Borderline Ovarian Tumors With Long-Term Follow-up. Int J Gynecol Cancer, 2016, 26(6):1053-1061.
36. Uzan C, Nikpayam M, Ribassin-Majed L, et al. Influence of histological subtypes on the risk of an invasive recurrence in a large series of stage I borderline ovarian tumor including 191 conservative treatments. Ann Oncol, 2014, 25(7):1312-1319.
37. Black JD, Altwerger GH, Ratner E, et al. Management of Borderline Ovarian Tumors Based on Patient and Tumor Characteristics. Gynecol Obstet Invest, 2015 Jun 6.[Epub ahead of print].

Chinese Journal of Evidence-Based Medicine

Effect of Laparoscopy versus Laparotomy on Recurrence for Borderline Ovarian Tumors: A Meta-analysis

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