Primary Laparoscopic Surgery Does Not Affect the Prognosis of Early-Stage Ovarian Clear Cell Cancer

Figures & data

Table 1 Clinical Characteristics

Characteristics	N=89	Laparoscopy (N=20)	Laparotomy (N=69)	P value
Median age (years)	51.0	49.0	53.0	0.124
FIGO stage
IA	37 (41.6%)	11 (55.0%)	26 (37.7%)
IB	2 (2.2%)	1 (5.0%)	1 (1.4%)
IC	50 (56.2%)	8 (40.0%)	42 (60.9%)	0.203
Median CA125 (U/mL)	43.5	25.0	63.0	0.393
Median CA199 (U/mL)	20.3	9.9	25.2	0.232
Tumor size (mm)
≤ 80	29 (32.6%)	10 (50.0%)	19 (27.5%)
> 80	54 (60.7%)	6 (30.0%)	48 (69.6%)
NA	6 (6.7%)	4 (20.0%)	2 (3.0%)	0.003
Ascites
None	72 (80.9%)	19 (95.0%)	53 (76.8%)
Yes	16 (18.0%)	1 (5.0%)	15 (21.7%)
NA	1 (1.1%)	0	1 (1.4%)	0.106
Laterality
Unilateral	87 (97.8%)	19 (95.0%)	68 (98.6%)
Bilateral	2 (2.2%)	1 (5.0%)	1 (1.4%)	0.401
Chemotherapy
Platinum-based	82 (92.1%)	19 (95.0%)	63 (91.3%)
Others	1 (1.1%)	0	1 (1.4%)
No chemo	6 (6.7%)	1 (5.0%)	5 (7.2%)	0.787
Chemo cycles
0	6 (6.7%)	1 (5.0%)	5 (7.2)
1–3	9 (10.1%)	4 (20.0%)	5 (7.2%)
≥ 4	74 (83.1%)	15 (75.0%)	59 (85.5%)	0.245

Abbreviations: FIGO, International Federation of Gynecology and Obstetrics; NA, not acquired.

Table 2 Surgical Procedures

Variable	N=89	Laparoscopy (N=20)	Laparotomy (n=69)	P value
Surgical procedures
Hysterectomy	80 (89.9%)	17 (85.0%)	63 (91.3%)	0.414
Mono/Bilateral SO	89 (100.0%)	20 (100.0%)	69 (100.0%)	1.000
Omentectomy	84 (94.4%)	15 (75.0%)	69 (100.0%)	0.000
Peritoneal biopsy	63 (70.8%)	11 (55.0%)	52 (75.4%)	0.097
Appendectomy	8 (9.0%)	2 (10.0%)	6 (8.7%)	1.000
Lymphadenectomy	66 (74.2%)	10 (50.0%)	56 (81.2%)	0.009
Pelvic only	19 (28.8%)	4 (40.0%)	15 (26.8%)
Aortic only	3 (4.5%)	0	3 (5.4%)
Pelvic & Aortic	44 (66.7%)	6 (60.0%)	38 (67.9%)
Laparotomic conversion
No		8 (40.0%)
Yes (Immediate staging)		10 (50.0%)
Yes (Delayed staging)		2 (10.0%)

Abbreviation: SO, salpingo-oophorectomy.

Figure 1 Kaplan–Meier plots for progression-free survival (A) and overall survival (B) between the laparoscopy and laparotomy groups.

Table 3 Characteristics of Recurrent Patients

No	Age	Stage	LNR	Chemo	Time to Recurrence (Mos)	Recurrent Sites	Treatment After Relapse	Status
1	57	IC	Yes	DC*6	28.0	Peritoneum	Surgery+Chemo	AWD
2	72	IC	No	TC*7	45.9	Pelvic	Surgery+Chemo	AWD
3	55	IC	Yes	TC*6	13.6	Liver parenchyma	Chemo	Dead
4	49	IC	Yes	TC*6	30.2	Lymph nodes	Surgery+Chemo	AWD
5	54	IC	Yes	TC*6	19.2	Ascites	Chemo	AWD
6	42	IA	Yes	TC*6	15.0	Peritoneum	Surgery+Chemo	Dead
7	48	IC	Yes	TC*6	12.6	Peritoneum	Chemo	Dead
8	51	IC	Yes	AC*7	12.0	Lymph nodes	Chemo	Dead
9	46	IA	Yes	TC*6	10.7	Pelvic	Surgery+Chemo	NED

Abbreviations: LNR, lymph node resection; DC, Docetaxel + Carboplatin; TC, Paclitaxel + Carboplatin; AC, Doxorubicin + Carboplatin; AWD, alive with disease; NED, no evidence of disease.

Table 4 References Comparing Survival Between Open Surgery and MIS for Ovarian Cancer Patients with Early Stage

Ref.^Citation22^–^Citation28	Patients	Group	Patients Number	Follow-Up (Months)	PFS Rate	OS Rate	Survival Difference
Ghezzi F. 2007	EOC	Open surgery	19	60 (32–108)	92.9%	100%
		Laparoscopy	15	16 (4–33)	100%	100%	NA
Park JY. 2008	EOC	Open surgery	33	23 (1–44)	100%	100%
		Laparoscopy	19	17 (2–40)	100%	100%	NA
Minig L, 2016	EOC	Open surgery	58	34.3 (28.4–47.8)	88% (51/58)	NA
		Laparoscopy	50	25.9 (11.2–38.5)	88% (44/50)	NA	N.S
Gallotta V, 2016	EOC	Open surgery	120	38 (24–48)	4-year: 81%	4-year: 91%
		Laparoscopy	60	38 (24–48)	4-year: 89%	4-year: 92%	N.S
Ditto A. 2017	EOC	Open surgery	50	52.6 (±81.8)	NA	NA
		Laparoscopy	50	49.5 (± 64)	NA	NA	N.S
Chang HT. 2020	OCCC	Open surgery	76	NA	73.7% (56/76)	86.8% (66/76)
		Laparoscopy	12	NA	83.3% (10/12)	91.7% (11/12)	N.S
Merlier M. 2020	EOC	Open surgery	107	42 (24.0–66.0)	71% (76/107)	84.1% (90/107)
		Laparoscopy	37	24 (11.0–50.0)	94.6% (35/37)	97.3% (36/37)	N.S

Abbreviations: MIS, minimally invasive surgery; EOC, epithelial ovarian cancer; OCCC, ovarian clear cell cancer; PFS, progression-free survival; OS, overall survival; NA, not acquired; N.S, none significance.

GhezziF, CromiA, UccellaS, et al. Laparoscopy versus laparotomy for the surgical management of apparent early stage ovarian cancer. Gynecol Oncol. 2007;105(2):409–413. doi:10.1016/j.ygyno.2006.12.02517275077

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GallottaV, PetrilloM, ConteC, et al. Laparoscopic versus laparotomic surgical staging for early-stage ovarian cancer: a Case-Control Study. J Minim Invasive Gynecol. 2016;23:769–774. doi:10.1016/j.jmig.2016.03.00626995493

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