Survival impact of initial surgical approach in stage I ovarian cancer

Tzu I. Wu, Chyi Long Lee, Pei Ju Liao, Kuan Gen Huang, Ting Chang Chang, Hung Hsueh Chou, Chin Jung Wang, Yung Kuei Soong, Swei Hsueh, Chyong Huey Lai

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14 Citations (Scopus)


Background: The aim of this study was to evaluate the impact on survival of initial laparoscopic surgery compared with conventional laparotomy in stage I epithelial ovarian cancer. Methods: We conducted a retrospective study which enrolled all consecutive patients with stage I epithelial ovarian cancer between January 1984 and December 2006. Patients with a histological diagnosis of epithelial ovarian cancer who underwent laparoscopy were recruited if their cases were compatible with stage I (clinical or surgical) at initial exploration. The independent samples t test, chi-square test, log-rank and Cox proportional hazards model were performed. Results: A total of 208 patients were enrolled, including 34 patients with initial laparoscopy and 174 with laparotomy. The median follow-up time for survivors was 65 (range, 2-276) months. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates were 67.4% and 69.5% in the laparoscopy 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 multivariate analysis, the initial laparoscopy approach posted significant adverse impacts 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 associated with only a worse OS, and its impact on the RFS was marginal. Conclusion: An initial laparoscopy intervention and higher substage posted significant adverse effects on the prognosis in stage I epithelial ovarian cancer. Important precautions when using laparoscopy for adnexal masses, such as avoiding rupture, applying protection, and submitting frozen sections, are recommended.

Original languageEnglish
Pages (from-to)558-567
Number of pages10
JournalChang Gung Medical Journal
Issue number5
Publication statusPublished - 2010
Externally publishedYes


  • Laparoscopy
  • Laparotomy
  • Ovarian cancer
  • Ovarian malignant neoplasm
  • Substage

ASJC Scopus subject areas

  • Medicine(all)


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