Comparison of Recurrence and Survival Between Patients With Pathological Stage I Epithelial Ovarian Cancer After Laparoscopic or Laparotomic Surgery: Retrospective Analysis of a Propensity-Matched Cohort

Abstract

Objective: To compare oncologic outcomes after laparoscopic or laparotomic surgery to treat epithelial ovarian carcinoma in FIGO Stage I.

Design: Retrospective cohort study.

Setting: Gynecological cancer ward in a tertiary hospital.

Participants: A total of 85 patients with FIGO Stage I epithelial ovarian carcinoma who underwent laparoscopic staging surgery and 206 who underwent laparotomic staging surgery at West China Second Hospital, Sichuan University (Chengdu, China) between January 1, 2013 and December 31, 2019.

Interventions: Laparoscopic surgery or laparotomic staging surgery.

Results: Before propensity score-based matching, the laparotomy group showed higher prevalence of preoperative elevated CA125 level (48.5% vs 35.3%, p = .045) and tumors >15 cm (27.2% vs 5.9%, p <.001). Multivariate analysis associated higher body mass index with better overall survival (adjusted HR 0.83, 95% CI 0.70-0.99, p = .043). Among propensity score-matched patients (82 per group) who were matched to each other according to propensity scoring based on age, body mass index, CA125 level, largest tumor diameter, FIGO stage, history of abdominal surgery, and American Society of Anesthesiologists grade, the rate of progression-free survival at 5 years was similar between the laparoscopy group (87.1%, 95% CI 79.3-95.7%) and the laparotomy group (90.9%, 95% CI 84.7-97.6%, p = .524), as was the rate of overall survival at 5 years (93.9%, 95% CI 88.0-100.0% vs 94.7%, 95% CI 89.8-99.9%, p = .900). Regardless of whether patients were matched, the two groups showed similar rates of recurrence of 9-11% during follow-up lasting a median of 54.9 months.

Conclusions: Rates of recurrence and survival may be similar between laparoscopy or laparotomy to treat Stage I epithelial ovarian cancer. Since laparoscopy is associated with less bleeding and faster recovery, it may be a safe, effective alternative to laparotomy for appropriate patients.

Keywords: Laparoscopy; Laparotomy; Ovary neoplasm; Propensity score; Retrospective study.