Laparoscopic Staging for Apparent Stage I Epithelial Ovarian Cancer: Analysis of the NCI Data Base (U.S.)

abstract

BACKGROUND:

While advances in minimally invasive surgery have made laparoscopic staging technically feasible in stage I epithelial ovarian cancer, the practice remains controversial due to an absence of randomized trials and lack of high-quality observational studies demonstrating equivalent outcomes.

OBJECTIVE:

This study seeks to evaluate the association of laparoscopic staging with survival among women with clinical stage I epithelial ovarian cancer.

STUDY DESIGN:

We used the National Cancer Data Base to identify all women who underwent surgical staging for clinical stage I epithelial ovarian cancer diagnosed from 2010-2012. The exposure of interest was planned surgical approach (laparoscopy versus laparotomy) and the primary outcome was overall survival. The primary analysis was based on intention-to-treat: all women whose procedures were initiated laparoscopically were categorized as having had a planned laparoscopic procedure regardless of subsequent conversion to laparotomy. We used propensity methods to match patients who underwent planned laparoscopic staging with similar patients who underwent planned laparotomy based on observed characteristics. We compared survival among the matched cohorts using the Kaplan-Meier method and Cox regression. We compared extent of lymphadenectomy using the Wilcoxon rank-sum test.

RESULTS:

Among 4,798 eligible patients, 1,112 (23.2%) underwent procedures which were initiated laparoscopically, of which 190 (17%) were converted to laparotomy. Women who underwent planned laparoscopy were more frequently white, privately insured, from wealthier zip codes, received care in community cancer centers, and had smaller tumors that were more frequently of serous, and less often of mucinous histology than those who underwent staging via planned laparotomy. After propensity score matching, time to death did not differ between patients undergoing planned laparoscopic versus open staging (Hazard Ratio=0.77, 95%CI=0.54-1.09; p=0.13). Planned laparoscopic staging was associated with a slightly higher median lymph node count (14 versus 12, p=0.005). Planned laparoscopic staging was not associated with time to death after adjustment for receipt of adjuvant chemotherapy, histological type and grade, and pathologic stage (Hazard Ratio 0.82, 95% CI 0.57-1.16).

CONCLUSION:

Surgical staging via planned laparoscopy versus laparotomy was not associated with worse survival in women with apparent stage I epithelial ovarian cancer.