| Background: Ovarian cancer is one of the three malignant tumors in the female reproductive system.The incidence rate of gynecologic tumors is only inferior to that of cervical cancer and uterine body cancer.In 2010,the American Cancer Association carried out a statistical survey of new cancers in various parts,ranking 9th in the number of new cases of ovarian cancer and 5th in the number of deaths.Because the ovary is located in the pelvic cavity,the diagnosis rate of early ovarian cancer is only 15%-20% when patients with ovarian cancer seek medical treatment.The histologic type of early ovarian cancer is mainly endometrial like cancer and clear cell cancer.After standardized operation and treatment,the 5-year survival rate of early ovarian cancer is more than 90%.80% of the patients with ovarian cancer were in advanced stage.The main histological type was serous cancer with poor differentiation.The 5-year survival rate was only 43%,and the prognosis was poor.About 200000 women are diagnosed with ovarian cancer every year around the world,and about 140000 women die of ovarian cancer.At present,the standard treatment of ovarian cancer is to carry out satisfactory tumor cell reduction on the basis of accurate diagnosis and staging,supplemented by platinum based chemotherapy.Patients in the late stage often need to receive enough courses of combined chemotherapy after staging or cytoreductive surgery.Because the residual volume of tumor after the first operation is the main factor that affects the prognosis of patients,therefore,the standardization and thoroughness of the initial operation is of great significance for patients with ovarian cancer.Therefore,the key to improve the curative effect of ovarian cancer is to seek the diagnosis and effective treatment of early ovarian cancer.In recent years,the application of laparoscopic surgery(LPS)in ovarian cancer is increasing,but there are still many controversies.The purpose of this study was to explore the efficacy and safety of LPS in EOC and its application in advanced ovarian cancer.Methods: the databases were searched,Pub Med,Cochrane Library,EMBASE,Wanfang database,CNKI.Chinese search terms include "ovarian cancer","laparoscopy","curative effect" and "early stage".English search terms include "ovarian neoplasm","ovary neoplasms","ovary can-cer","peritoneoscope","laparoscope","laparotomies" and "early stage" to search these databases from January 1,1990 to February 20,2020.Literature types include randomized controlled studies,retrospective case-control studies,reviews,and guidelines.The outcome measures included: operation time,intraoperative hemorrhage,pelvic lymph nodes,paraaortic lymph nodes,total lymphadenectomy,number of blood transfusion cases,intraoperative complication rate,postoperative complication rate,postoperative exhaust time,hospitalization time,recurrence rate,3-year survival rate,intraoperative tumor rupture rate,interval time of chemotherapy and stage rise.All statistical analysis was carried out by using stata11.0 software.Conclusion: totally 2461 patients with early ovarian cancer were included in 37 literatures.All of them were case-control studies of laparoscopic and laparotomy for comprehensive staging of early ovarian cancer,including 1247 patients in laparoscopic surgery group and 1416 patients in laparotomy group.The age,BMI or body mass,pathological stage and case classification of the two groups were comparable.The operation time,intraoperative hemorrhage,pelvic lymph node,paraaortic lymph node,total lymph node resection,blood transfusion cases,intraoperative complications,postoperative complications,postoperative exhaust time,hospitalization time,recurrence rate,3-year survival rate,intraoperative tumor rupture rate,chemotherapy interval time,and the rate of stage rise were compared between the two groups.Using stata11.0 software for data analysis,the results showed that there was no statistical significance in the operation time of LPS and LPT groups(MD = 6.08,95% CI =-9.36-21.53,P = 0.440).There was significant difference between LPS and LPT(MD =-177.69,95% CI =-231.33 ?-142.06,P = 0.000).and the amount of bleeding in LPS group was less than that in LPT group.There was no significant difference in the number of paraaortic lymph nodes in LPS and LPT groups(MD = 1.15,95% CI =-0.16-2.46,P = 0.085).There was no significant difference in the number of pelvic lymphadenectomy between LPS and LPT groups(MD = 1.90,95% CI =-0.58-4.38,P = 0.133).There was no significant difference in the total number of lymph node resections between LPS and LPT groups(MD = 1.71,95% CI =-0.61-4.03,P = 0.148).There was no significant difference in the number of tumor rupture cases between LPS and LPT groups(or = 1.21,95% CI = 0.69-2.12,P = 0.514).There was no significant difference in the number of complications between LPS and LPT(or = 1.02,95% CI = 0.56-1.84,P = 0.956).The number of postoperative complications in LPS group and LPT group was statistically significant(or = 0.27,95% CI = 0.20-0.36,P = 0.000),and the incidence of postoperative complications in LPS group was lower than that in LPT group.The number of blood transfusions in LPS and LPT groups was statistically significant(or = 0.19,95% CI = 0.12-0.30,P = 0.000),and the number of blood transfusions in LPS group was less than that in LPT group.There was a significant difference in the postoperative exhaust time between LPS group and LPT group(SMD =-1.75,95% CI =-2.12 ?-1.38,P = 0.000),and the postoperative exhaust time of LPS group was shorter than that of LPT group.The hospitalization time of LPS group and LPT group was statistically significant(MD =-3.91,95% CI =-4.58 ?-3.24,P = 0.000),and the postoperative hospitalization time of LPS group was shorter than that of LPT group.The interval time between the first chemotherapy in LPS and LPT group was statistically significant(MD =-3.21,95% CI =-4.29 ?-2.13,P = 0.000),and the first chemotherapy time in LPS group was shorter than that in LPT group.There was no significant difference between LPS and LPT(or = 0.78,95% CI = 0.48-1.28,P = 0.312).The recurrence of LPS and LPT was statistically significant(or = 0.71,95% CI = 0.51-0.98,P = 0.039),and the recurrence of LPS group was less than that of LPT group.There was no significant difference between LPS and LPT(or = 1.00,95% CI = 0.47-2.15,P = 0.993).There was no significant difference in 3-year survival rate between LPS and LPT(or = 0.83,95% CI = 0.42-1.62,P = 0.579). |
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