Intervention Review

Laparoscopy versus laparotomy for benign ovarian tumour

  1. Lídia RF Medeiros1,*,
  2. Daniela D Rosa2,
  3. Mary C Bozzetti3,
  4. Jandyra MG Fachel4,
  5. Susan Furness5,
  6. Ray Garry6,
  7. Maria INES Rosa7,
  8. Airton T Stein8

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 15 APR 2009

Assessed as up-to-date: 9 NOV 2007

DOI: 10.1002/14651858.CD004751.pub3

Database Title

Additional Information

How to Cite

Medeiros LRF, Rosa DD, Bozzetti MC, Fachel JMG, Furness S, Garry R, Rosa MINES, Stein AT. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD004751. DOI: 10.1002/14651858.CD004751.pub3.

Author Information

  1. 1

    Federal University of Rio Grande do Sul, Social Medicine/Epidemiology, Porto Alegre, Rio Grande do Sul, Brazil

  2. 2

    Hospital Femina - Grupo Hospitalar Conceicao, Porto Alegre, Rio Grande do Sul, Brazil

  3. 3

    Faculty of Medicine at Federal University of Rio Grande do Sul, Social Medicine, Rio Grande do Sul, Brazil

  4. 4

    Universidade Federal do Rio grande do Sul (UFRGS), Departmento de Estatistica, Instituto de Matematica, Porto Alegre, Brazil

  5. 5

    The University of Manchester, Cochrane Oral Health Group, School of Dentistry, Manchester, UK

  6. 6

    University of Tesside and South Cleveland Hospital, Middlesbrough, Gynaecological Surgery, Guisborough, Yorkshire, UK

  7. 7

    Universidade do Extremo Sul Catarinense, Medical School, Criciuma, Santa Catarina, Brazil

  8. 8

    Universidade Federal de Ciências da Saúde, Department of Public Health, Porto Alegre, Brazil

*Lídia RF Medeiros, Social Medicine/Epidemiology, Federal University of Rio Grande do Sul, Jose de Alencar 1244, 1009 Menino Deus, Porto Alegre, Rio Grande do Sul, 90880-480, Brazil. lidia.rosi@terra.com.br. lidiarosi@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Over the last 10 years laparoscopy and minilaparotomy have become increasingly common approaches for the surgical removal of benign ovarian tumours. However, in the event that a tumour is found to be malignant, laparotomy is the appropriate procedure. Careful preoperative assessment including transvaginal ultrasound with morphological scoring, colour doppler assessment of vascular quality, and serum cancer antigen 125 (CA 125) level is desirable.

Objectives

To determine the benefits, harms, and cost of laparoscopy or minilaparotomy compared with laparotomy in women with benign ovarian tumours.

Search methods

We searched electronic databases, trial registers, and reference lists of published trial reports. Reference lists from trials and review articles were searched.

Selection criteria

All randomised controlled trials comparing either laparoscopy or minilaparotomy with laparotomy for benign ovarian tumours.

Data collection and analysis

Eight review authors independently assessed the eligibility and quality of each study and extracted the data.

Main results

The results of nine randomised controlled trials (N = 482 women) showed that laparoscopic surgery was associated with fewer adverse events of surgery (surgical injury or postoperative complications including fever or infection) (OR 0.3, 95% CI 0.2 to 0.5), less postoperative pain (VAS score WMD -2.4, 95% CI -2.7 to -2.0), greater likelihood of being pain free after two days (OR 7.42, 95% CI 4.86 to 11.33), and fewer days in hospital (WMD -2.88, 95% CI -3.1 to -2.7) than with laparotomy.

In one study that reported costs, laparoscopy was associated with a significant reduction in costs compared to laparotomy (WMD - USD 1045, 95% CI -1348 to -742) in 1993. Very high levels of heterogeneity made it inappropriate to pool data on duration of surgery.

Three RCTs compared laparoscopy versus minilaparotomy and found that laparoscopy was associated with reduced odds of any adverse event (surgical injury or postoperative complications) (OR 0.10, 95% CI 0 to 0.8) and lower VAS scores for pain (WMD -1.0, 95% CI -1.6 to -0.45). Duration of hospital stay ranged between 1 and 2.2 days, with substantial heterogeneity.

Authors' conclusions

In women undergoing surgery for benign ovarian tumours, laparoscopy was associated with a reduction in fever, urinary tract infection, postoperative complications, postoperative pain, number of days in hospital, and total cost. These findings should be interpreted with caution since only a small number of studies were identified. These included a total of only 769 women and not all of the important outcomes were reported in each study.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Laparoscopic surgery for benign ovarian tumours is associated with less pain, shorter hospital stay, and fewer adverse events than with laparotomy

Laparoscopy is a modern surgical technique in which operations are performed through small incisions (usually 2 to 3 cm long) using a laparoscope. This is a telescopic rod lens system that is usually connected to a video camera. In the 12 controlled studies identified, laparoscopic surgery was associated with reduced risk of any adverse events from surgery, less pain, and fewer days in the hospital when compared to laparotomy, the traditional surgical technique.There was no difference between the procedures with regard to outcomes of fever, postoperative infections, and tumour recurrence.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

腹腔鏡手術與剖腹手術對於良性卵巢瘤之比較

在過去10年間，腹腔鏡手術已經成為手術移除良性卵巢瘤所日益常用之方法。但是此種介入治療之價值仍不確定。茲進行本回顧以評估可得之證據，說明良性卵巢瘤之腹腔鏡手術相較於剖腹手術的益處及害處。

目標

判定腹腔鏡手術相較於剖腹手術對於具有假定為良性之卵巢瘤之婦女的功效、安全性、及治療成本。

搜尋策略

我們搜尋發表文章的電子資料庫, 試驗登錄庫以及參考資料清單。並搜尋文獻回顧。

選擇標準

針對良性卵巢瘤而比較腹腔鏡與剖腹手術之所有隨機對照試驗。

資料收集與分析

由3位回顧作者獨立評估各項研究之適用性及品質並摘錄數據。

主要結論

共搜尋到包括324名病患之6項隨機對照試驗。考慮三組卵巢瘤之次型：任何組織學類型之良性卵巢瘤、皮樣囊腫、及子宮內膜異位囊腫。. 手術結果：相較於剖腹手術整體而言，腹腔鏡手術組之平均手術時間較長 (WMD 11.39; 95% CI 0.57 to 22.22) 。然而，存在異質性導致潛在的不一致性 (I2 = 87%) 。此等分析中所見到之異質性可能係反映病患族群之差異。. 手術之不良作用：相較於剖腹手術，腹腔鏡手術有較低之術後發燒累積預估值 (Peto OR 0.34; 95% CI 0.13 to 0.88) 。腹腔鏡手術後發生任何手術不良作用之機率 (併發症總數  手術損傷及／或術後併發症) 亦為較低 (Peto OR 0.26; 95% CI 0.12 to 0.55) 。. 短期復原情形：VAS疼痛分數以腹腔鏡手術較佔優勢 (WMD −2.36; 95% CI −2.07 to −2.03) ，而相較於剖腹手術，腹腔鏡手術之無痛機率顯著較高 (Peto OR 7.35; 95% CI 4.3 to 12.56) 。腹腔鏡手術組之平均留院期較短，較剖腹手術組減少2.79天 (95% CI −2.95 to −2.62) 。. 治療成本結果: 在其中一項針對具有任何類型良性卵巢瘤之婦女所進行之試驗中，相對於剖腹手術組，腹腔鏡手術組具有減少1045美元之顯著成本降低 (95% CI1361 to −726.97) 。

作者結論

就進行良性卵巢瘤手術之婦女而言，腹腔鏡手術可降低下列諸項：術後發燒、尿道感染、術後併發症、術後疼痛、留院日數、以及總治療成本。此等發現應予小心詮釋，因本回顧僅辨識出總共包括324名婦女之少數研究，且並非所有之重要結果皆在各個研究中有報告。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

良性卵巢瘤之腹腔鏡手術具有較低之疼痛情形、較短之留院期、以及較少之不良作用。在本回顧所辨識之少數研究中，相較於剖腹手術，良性卵巢瘤之腹腔鏡手術具有較低之手術不良作用風險、較少之疼痛情形、以及較短之留院天數。就發燒、術後感染、以及腫瘤復發而言，該等手術之間並無差異。

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