| Ovarian neoplasm is one of the most common tumors in female genital and the main treatment is resection operation. Therefore, the laparoscopic surgery is widely applied in the field of gynecology which is well-known for the merits of little trauma and quick recovery. Laparoscopic surgery has become the preferred surgical approach to benign ovarian tumor. With the continuous improvement of laparoscopic skills and operational techniques, the laparoscopic comprehensive staging surgery for early-stage ovarian cancer is increasingly mature, in the mean time, the laparoscopic treatment for advanced ovarian cancer is gradually carried out. However, there are still some controversial clinical issues in the laparoscopic application to ovarian cancer. Therefore, it is necessary for us to use the approach of evidence-based medicine to evaluate the role of laparoscopic surgery in the treatment of ovarian tumors. In this study, the research conducted a Meta-analysis of the benign ovarian tumor in senile Chinese women, laparoscopic surgery in early-stage and advanced ovarian cancer, and a highly credible conclusion is obtained as evidence, in this way, best decisions for patients with treatment can be made.Part ? Comparative effects of laparoscopic treatment and laparotomy for benign ovarian tumor in senile Chinese women: A meta-analysisObjective: Collecting the published documents at home and abroad, comparing the effects of laparoscopic treatment(LPS) and laparotomic operation(LPT) for benign ovarian tumor in senile Chinese women by Meta-analysis.Methods: Formulating the inclusion, exclusion criteria and searching strategy; searching the documents from 1990-01-01 to 2014-08-30 on the effects of LPS as well as LPT for benign ovarian tumor in senile Chinese women in Wan Fang database, CNKI, VIP, China Biology Medicine(CBM) by taking "fu qiang jing ", "luan chao ", "liang xing ", "lao nian" as Chinese index terms. Screening documents according to inclusion standard, extracting the information, and assessing the quality of the inclusion information by two valuators independently; performing statistical analysis of the operation time, intraoperative blood loss, postoperative anal exhaust time, postoperative complications and hospitalization time by Rev Man 5.3.4 software.Results: A total of 9 studies of CCTs met the inclusion criteria without exception of RCTs. The basic characteristics of laparoscopic group and laparotomic group are balanced. Comparing to laparotomic group, the laparoscopic group had shorter operation time, less amount of bleeding, earlier anal exhaustion, lower complication rate and shorter hospitalization time. In addition, there was significant difference between the two groups(P<0.05). [operation time: MD=-14.03, 95%CI(-21.58,-6.49), P<0.05; intraoperative blood loss: MD=-38.85, 95%CI(-47.41,-30.29), P<0.05; anal exhaust time: MD=-15.78, 95%CI(-19.88,-11.68), P<0.05; postoperative complications: OR=0.22, 95%CI(0.13, 0.35), P<0.05; hospitalization time: MD=-3.63, 95%CI(-4.50,-2.77),P<0.05.].Conclusion: Laparoscopic surgery is an ideal procedure for benign ovarian tumor in senile Chinese women for little trauma, quick recovery and low complication occurrence.Part ? Laparoscopy and laparotomy in comprehensive staging operation of early-stage ovarian cancer: a Meta-analysisObjective: Collecting the published documents at home and abroad and comparing the effects of comprehensive staging LPS and LPT for early-stage ovarian cancer in order to provide reliable evidence for clinical practice.Methods: Formulating the inclusion and exclusion criteria; searching the documents from 1990-01-01 to 2014-02-12 for the effects of comprehensive staging LPS as well as LPT in the database of Pubmed, Embase, Cochrane Library, Wan Fang database, CNKI, China Biology Medicine(CBM) by searching "ovarian cancer", "ovarian carcinoma", "ovarian neoplasm", "ovarian adenocarcinoma", "oophoroma", "laparoscopy", "early stage" as English search terms,and "luan chao ai", " luan chao e xing zhong liu", "fu qiang jing", "zao qi" as Chinese search terms according to the inclusion and exclusion standard in a strict way; collecting information by two valuators independently; extracting the information and assessing the quality of the included documents. Rev Man 5.2.9 software were used to analyze the operative time, intraoperative blood loss, number of lymph node dissection, incidence of intraoperative tumor rupture, postoperative anal exhaust time, incidence of surgical complications, postoperative pain scores(VAS), hospitalization time, recurrence rate and postoperative mortality.Results: In the 18 documents according with the inclusion criteria, there were no RCTs and all were CCTs including 434 LPS patients and 788 LPT patients. The basic characteristics of laparoscopic group and laparotomic group are balanced. Comparing to laparotomic group,the laparoscopic group has less amount of bleeding [MD=-207.86, 95%CI(-285.87,-129.86), P<0.05], earlier anus exhaust time[MD=-25.26, 95%CI(-31.07,-19.45), P<0.05], lower surgical complication incidence [OR=0.30, 95%CI(0.20, 0.45), P<0.05], fewer pains[MD=-2.84, 95%CI(-4.39,-1.29), P<0.05], shorter hospitalization time[MD=-4.57, 95%CI(-6.36,-2.77), P<0.05]. There was statistical significance between the two groups(P<0.05). But there was no statistical significance in operation time [MD=26.18, 95%CI(-3.85, 56.20), P =0.09], number of lymph node dissection [MD=-0.80, 95%CI(-2.00, 0.40), P =0.19], intraoperative tumor rupture[OR=0.85, 95%CI(0.37, 1.95), P=0.70], postoperative recurrence rate [OR=0.56, 95%CI(0.25, 1.25), P=0.16] and postoperative mortality [OR=1.56, 95%CI(0.83, 2.95), P=0.17] between the two groups(P>0.05).Conclusion: The comprehensive staging laparoscopic surgery has little trauma and quick recovery, long-term effects are not significantly different compared with laparotomy. However, we obtained few including document samples, which are not supported by RCT. Therefore, large-scale and polycentric RCT are badly needed and depended on in the future in order to make more persuasive evaluation.Part ? Laparoscopy for diagnosing resectability of disease in patients with advanced ovarian cancer: a Meta-analysisObjective: Collecting published documents at home and abroad; evaluating comprehensively the diagnostic value of laparoscopy for satisfactory cytoreductive surgery in patients with advanced ovarian cancer by Meta-analysis to provide credible and predictable clinical means for assessing the diagnostic value of laparoscopy for satisfactory cytoreductive surgery in patients with advanced ovarian cancer, furthermore, to provide evidence-based medicine for clinical application and generalization.Methods: Collecting materials according with the related guidelines provided by diagnostic Meta-analysis and formulating the inclusion and exclusion criteria; searching the documents from 1990-01-01 to 2014-10-11 in the database of Pubmed, Embase, Cochrane Library, Wan Fang database, CNKI, China Biology Medicine(CBM) by searching "advanced", "ovarian cancer", "ovarian carcinoma", "ovarian neoplasm", "ovarian adenocarcinoma", "oophoroma", "laparoscopy" as English search terms, and "luan chao ai", " luan chao e xing zhong liu", "fu qiang jing", "zao qi" as Chinese search terms; collecting information by two valuators independently; extracting related information and assessing the quality of the included documents by QUADAS-2 and analyze it by Meta-Disc 1.4. Obtaining the data such as TP,FP,TN and FN from the independent researches; drawing the summary receiver operating characteristic(SROC) in order to estimate the whole diagnostic test. Without threshold effect, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio and other indicators are combined. The included documents are removed one by one before comparing the AUCs of the SROC by using Z test, in the end, the sensitivity analysis of the included documents is conducted.Results: Ten studies were included in our Meta-analysis and 1045 patients were involved. Spearman correlation is-0.685 and P is 0.029 which says that there is threshold effect in the whole study. Therefore it is inappropriate to combine sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and other indicators. AUC of SROC is 0.9874(SE=0.0051), Q is 0.9523(SE=0.0115). Meta-analysis was conducted again after removing the included documents one by one and we found that the AUC of SROC didn't change much, which means that the quality of all included documents is reliable and credible.Conclusion: Laparoscopy showed high efficiency in evaluation satisfactory cytoreductive surgery on patients with advanced ovarian cancer and it is a promising exploratory method. In addition, laparoscopy should be combined with other diagnostic methods to further improve the sensitivity and specificity in diagnosing the satisfactory cytoreductive surgery in patients with advanced ovarian cancer. |
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