The Clinical Value Of The Laparoscopic Surgery Of Ovarian Cancer:a Meta Analysis

Objective:Use the systematic review and meta analysis to evaluate of the clinical value of laparoscopic surgery of ovarian cancer.Materials and Methods:We searched the databases of Pubmed, Medline, Science Direct, Elsevier, CJFD, CNKI, ect. In the library of Shandong University, We also hand-searched4journals of obstetrics and gynecology. The limited time was to the end of2012. The language was only in English or Chinese. The experimental group was treated by laparoscopic surgery and the control group was by laparotomy. Selecting trials based on strict including and excluding criteria. All the data were analyzed by Review Manager5.0software. The items we analyzed were including operating time, estimated blood loss, pelvic and para-aortic lymph node dissection, operative complications, hospital stay, recurrence rate and death rate, with the two surgical treatments. Using the index of Odds Ratio(OR) to express the result for the categorical variable and Weighted Mean Difference(WMD) to express the result for the continuous variable respectively.Result:There are eleven trials including660patients included. There is no significant difference between two groups in both age and BMI. Results show that:1. The difference of operating time of two groups is statistically significant, WMD=46.81,95%CI:(7.92,85.69), p=0.02. Because there exists heterogeneity, the sensitivity of this analysis is of a low credibility, and it cannot explain that the laparoscopic surgery is longer than laparotomy on operative time.2. The difference in estimated blood loss of two groups is statistically significant, WMD=-163.32,95%CI:(-186.85,-139.79), p<0.00001. The estimated blood loss of laparoscopy group is less than laparotomy group.3. There is no significant difference in lymph node dissection between two groups, all results are p>0.05.4. The difference in operative complications of two group is statistically significant, p<0.00001. The complication of laparoscopy group is less common than that in laparotomy group. The study of intraoperative complications has no meaningful results. Maybe it is related to the small sample size, the surgeon operative level, et al.5. There isa significant difference of hospitalization between two groups, WMD=-4.28,95%CI:(-6.11,-2.44), p<0.00001, the hospitalization of laparoscopy group is less than that in laparotomy group.6. The recurrence rate of laparoscopic group compared to laparotomy group has statistically significant difference. Combined with clinical experience and quality of literature, the result should be conservative.7. Compared the mortality of two group, OR=0.72,95%CI:(0.19,2.78), p=0.63, there is no significant difference.Conclusion:Laparoscopic surgery and laparotomy for ovarian cancer have no statistically significant difference in lymph node dissection, intraoperative complications and mortality. Although compared to laparotomy group, the operating time is longer in laparoscopy group, it has less blood loss, fewer postoperative and total complications, and shorter hospitalization. In conclusion, the laparoscopy for ovarian cancer is a safe, feasible and accurate operation, although the follow-up time was relatively shorter and need more related research.