微创手术与开腹手术治疗上皮性卵巢癌的有效性和安全性:系统回顾和荟萃分析。

IF 4.5 2区 医学 Q1 OBSTETRICS & GYNECOLOGY
Gynecologic oncology Pub Date : 2024-11-01 Epub Date: 2024-08-16 DOI:10.1016/j.ygyno.2024.08.011
Akira Yokoi, Hiroko Machida, Muneaki Shimada, Koji Matsuo, Shogo Shigeta, Shigenori Furukawa, Nobumichi Nishikawa, Hiroyuki Nomura, Kensuke Hori, Hideki Tokunaga, Tadahiro Shoji, Tsukasa Baba, Satoru Nagase
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引用次数: 0

摘要

目的研究微创手术(MIS)和传统腹部手术治疗上皮性卵巢癌(EOC)的有效性和安全性,并按治疗类型进行分层:方法:日本妇科肿瘤学会卵巢癌委员会的专家小组进行了系统回顾和荟萃分析。日本医学图书馆协会于 2023 年 11 月 11 日使用关键词 "上皮性卵巢癌"、"微创手术"、"腹腔镜 "和 "机器人辅助 "检索了多个学术数据库,包括 PubMed/MEDLINE、Cochrane Database 和 Ichushi。由两位作者独立评估描述微创手术治疗 EOC 与传统腹部手术比较的文章。主要结果是生存率和围手术期不良事件:结果:在筛选了1114项研究后,确定了35篇文章,其中包括早期EOC的初级分期手术(PSS)(n = 20)和间歇分期手术后的新辅助化疗(NACT-IDS;n = 10),以及晚期EOC的前期初级分期手术(PDS;n = 5)。这些研究共纳入29888例患者(7661例接受MIS手术,22227例接受腹部手术)。接受MIS和腹部手术的患者总生存率相似(PSS:几率比[OR]1.02,95%置信区间[CI]0.75-1.37;NACT-IDS:OR 0.93,95%置信区间[CI]0.75-1.37):OR为0.93,95%CI为0.25-3.44;PDS:OR为0.66,95%CI为0.36-1.22,所有P均大于0.05)。MIS 的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 的淋巴结清扫率(PSS:OR 0.49,95%CI0.26-0.91)和晚期 EOC 的多脏器切除率(NACT-IDS:OR 0.27,95%CI 0.16-0.44;PDS:OR 0.27,95%CI 0.16-0.44)在 MIS 中均低于腹部手术(所有 P 均为 0.05):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MIS是一种可行的选择,但不同的病例选择和手术方法可能会产生偏差,需要进一步的验证研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Efficacy and safety of minimally invasive surgery versus open laparotomy for epithelial ovarian cancer: A systematic review and meta-analysis.

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).

Conclusion: 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.

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来源期刊
Gynecologic oncology
Gynecologic oncology 医学-妇产科学
CiteScore
8.60
自引率
6.40%
发文量
1062
审稿时长
37 days
期刊介绍: Gynecologic Oncology, an international journal, is devoted to the publication of clinical and investigative articles that concern tumors of the female reproductive tract. Investigations relating to the etiology, diagnosis, and treatment of female cancers, as well as research from any of the disciplines related to this field of interest, are published. Research Areas Include: • Cell and molecular biology • Chemotherapy • Cytology • Endocrinology • Epidemiology • Genetics • Gynecologic surgery • Immunology • Pathology • Radiotherapy
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