Survival Impact of Initial Surgical Approach in Stage I Ovarian Cancer

Background: The aim of this study was to evaluate the impact on survival of initial laparoscopicsurgery compared with conventional laparotomy in stage I epithelialovarian cancer.Methods: We conducted a retrospective study which enrolled all consecutive patientswith stage I epithelial ovarian cancer between January 1984 and December2006. Patients with a histological diagnosis of epithelial ovarian cancer whounderwent laparoscopy were recruited if their cases were compatible withstage I (clinical or surgical) at initial exploration. The independent samples ttest, chi-square test, log-rank and Cox proportional hazards model were performed.Results: A total of 208 patients were enrolled, including 34 patients with initiallaparoscopy and 174 with laparotomy. The median follow-up time for survivorswas 65 (range, 2-276) months. The 5-year overall survival (OS) andrecurrence-free survival (RFS) rates were 67.4% and 69.5% in thelaparoscopy group, and 88.7% and 78.7% in the laparotomy group, respectively.The median time to recurrence was 14.5 (range, 2-67) months. In multivariateanalysis, the initial laparoscopy approach posted significant adverseimpacts on the OS (laparoscopy vs laparotomy, the hazard ratio [HR]: 3.52, p= 0.009) and the RFS (laparoscopy vs laparotomy, HR: 2.58, p = 0.024),while a higher substage (stage IB-IC vs IA, HR: 8.29, p = 0.040) was associatedwith only a worse OS, and its impact on the RFS was marginal.Conclusion: An initial laparoscopy intervention and higher substage posted significantadverse effects on the prognosis in stage I epithelial ovarian cancer.Important precautions when using laparoscopy for adnexal masses, such asavoiding rupture, applying protection, and submitting frozen sections, arerecommended.