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 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.