Laparoscopy versus laparotomy for FIGO stage 1 ovarian cancer (Review)

Background This is an updated version of the original review that was first published in the Cochrane Database of Systematic Reviews 2008, Issue 4. Laparoscopy has become an increasingly common approach to surgical staging of apparent early-stage ovarian tumours. This review was undertaken to assess the available evidence on the benefits and risks of laparoscopy compared with laparotomy for the management of International Federation of Gynaecology and Obstetrics (FIGO) stage I ovarian cancer. Objectives To evaluate the benefits and risks of laparoscopy compared with laparotomy for the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic). Search methods For the original review, we searched the Cochrane Gynaecological Cancer Group Trials (CGCRG) Register, Cochrane Central Register of Controlled Trials (CENTRAL 2007, Issue 2), MEDLINE, EMBASE, LILACS, Biological Abstracts and CancerLit from 1 January 1990 to 30 November 2007. We also handsearched relevant journals, reference lists of identified studies and conference abstracts. For this updated review, we extended the CGCRG Specialised Register, CENTRAL, MEDLINE, EMBASE and LILACS searches to 6 December 2011. Selection criteria Randomised controlled trials (RCTs), quasi-RCTs and prospective cohort studies comparing laparoscopic staging with open surgery (laparotomy) in women with stage I ovarian cancer according to FIGO. Data collection and analysis There were no studies to include, therefore we tabulated data from non-randomised studies (NRS) for discussion. Main results We performed no meta-analyses. Authors’ conclusions This review has found no good-quality evidence to help quantify the risks and benefits of laparoscopy for the management of earlystage ovarian cancer as routine clinical practice

Laparoscopy versus laparotomy for benign ovarian tumour

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 orminilaparotomy 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

Laparoscopy versus laparotomy for FIGO stage 1 ovarian cancer (Review)

Background Over the past ten years laparoscopy has become an increasingly common approach for the surgical removal of early stage ovarian tumours. There remains uncertainty about the value of this intervention. This review has been undertaken to assess the available evidence of the benefits and harms of laparoscopic surgery for the management of early stage ovarian cancer compared to laparotomy. Objectives To evaluate the benefits and harms of laparoscopy in the surgical treatment of FIGO stage I ovarian cancer (stages Ia, Ib and Ic) when compared with laparotomy. Search methods Trials were identified by searching the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL),TheCochrane Library Issue 2, 2007,MEDLINE (January 1990 toNovember 2007), EMBASE (1990 toNovember 2007), LILACS (1990 toNovember 2007), BIOLOGICALABSTRACTS (1990 toNovember 2007) andCancerlit (1990 toNovember 2007). We also searched our own publication archives, based on prospective handsearching of relevant journals from November 2007. Reference lists of identified studies, gynaecological cancer handbooks and conference abstract were also scanned. Selection criteria Studies including patients with histologically proven stage I ovarian cancer according to the International Federation of Gynaecology and Obstetrics (FIGO). Studies comparing laparoscopic surgery with laparotomy for early stage ovarian cancer were only available from1990. It was anticipated that a very small number of randomised controlled trials (RCTs) were conducted studying themanagement of early stage ovarian cancer. Therefore, non-randomised comparative studies, cohort studies and case-controls studies, but not studies with historical controls, were also considered. Data collection and analysis Data extraction was performed independently by five review authors (LRM, DDR, MIR, MCB and MIE) who assessed study quality and quality of extracted data. Extracted data included trial characteristics, characteristics of the study participants, interventions and outcomes. The quality of non RCTs was assessed using appropriate quality evaluations tools from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and from the Newcastle-Ottawa tool for observational studies (NOS). Main results No RCTs were identified. Three observational studies were identified. Authors’ conclusions This review has found no evidence to help quantify the value of laparoscopy for the management of early stage ovarian cancer as routine clinical practice

Laparoscopia versus laparotomia nas tumorações ovarianas benignas

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Revisão sistemática com enfoque diagnóstico e terapêutico das tumorações ovarianas

Introdução: Em cirurgia ginecológica, o tratamento dos tumores ovarianos é tema que suscita inúmeras controvérsias quanto à melhor abordagem − se por laparoscopia ou por laparotomia. Entretanto, nos casos de neoplasia maligna de ovário, o manejo por essa via torna-se inadequado, em decorrência das pequenas incisões que dificultam os cuidados operatórios preconizados para essas neoplasias. Quando uma tumoração ovariana é detectada, faz-se necessário estabelecer suas características de benignidade ou malignidade, sendo que determinados exames, de certa forma, guiam a conduta terapêutica a ser adotada, apesar de não possuírem 100% de acurácia. Esses exames são a ultra-sonografia transvaginal com Doppler colorido, o marcador tumoral CA 125 e o exame anatomopatológico de congelação durante o ato cirúrgico. Devido às incertezas que suscitam controvérsias quanto à melhor abordagem inicial para o manejo operatório das tumorações ovarianas, se por laparoscopia ou por laparotomia, planejamos realizar estudos de revisão sistemática. A revisão sistemática com enfoque terapêutico, comparou laparoscopia e laparotomia, na abordagem cirúrgica do câncer ovariano, em seus estágios iniciais (Ia, Ib, Ic) pela Federação Internacional de Ginecologia e Obstetrícia (FIGO). Estudos de revisão sistemática, com enfoque diagnóstico, avaliaram a acurácia diagnóstica da ultra-sonografia com Doppler colorido, do CA 125 e do exame anatomo-patológico de congelação. Conclusão A revisão sistemática com enfoque terapêutico – laparoscopia versus laparotomia para câncer ovariano em estágio inicial (Ia, Ib,Ic) pela FIGO – não encontrou evidências que apóiem o uso da laparoscopia para o manejo inicial do câncer ovariano em seus estágios iniciais como rotina na prática clínica. Verifica-se a necessidade de estudos com boa qualidade metodológica comparando laparoscopia e laparotomia para o manejo cirúrgico inicial desses tipos de câncer.Assim como a importância da classificação correta do desenho clínico dos estudos observacionais tanto pelos autores, bem como pelos revisores dos periódicos, visto que tivemos 2 artigos de coorte classificados erroneamente como sendo de casos e controles. A revisão sistemática com enfoque diagnóstico do exame de anatomopatológico de congelação Conclui-se, assim, que a acurácia do exame de anatomopatológico de congelação é elevada no diagnóstico de tumores malignos e benignos, sendo baixa, porém, para as lesões com malignidade limítrofe. A revisão sistemática, com enfoque diagnóstico, da ultra-sonografia com Doppler é um exame pré-teste importante na predição da natureza da tumoração ovariana – se maligna ou benigna. A revisão sistemática com enfoque diagnóstico do CA 125 com nívell sérico ≥ 35 U/ml é importante, nas tumorações ovarianas, para predizer se a lesão ovariana é de natureza benigna ou maligna. Em síntese, estes quatros estudos de revisão sistemática que abordam as tumorações ovarianas, mostraram níveis de evidência baixo para abordagem laparoscópica no câncer ovariano estágios inicias (Ia, Ib e Ic) pela FIGO. E que os três exames diagnósticos mais realizados na presença de tumoração ovariana são extremamente importantes para definir o diagnóstico. Definindo-se o diagnóstico, cabe adotar a melhor opção terapêutica.Introduction: In gynecological surgery, the treatment of the ovarian tumors is theme that raises countless controversies with relationship to the best approach if for laparoscopy or for laparotomy. However, in the cases of malignancy of ovarian tumor, the handling for that road becomes inadequate, due to the small incisions that hinder the operative cares extolled for those neoplasias. When an ovarian tumor is detected, it is necessary to establish its characteristics of benignancy or malignancy, and certain exams, in a certain way, guide the therapeutic conduct to be adopted one, in spite of they do not possess 100% of accuracy. Those exams are the ultrasonography with color Doppler, CA 125 assay and accuracy of frozen section the diagnosis of ovarian tumors. Due to the uncertainties that raise controversies regarding the relationship of the best initial approach for the operative handling of the ovarian tumor, if laparoscopy or laparotomy, we planned to accomplish studies of systematic review. The systematic review with therapeutic focus, compared laparoscopy and laparotomy, in the surgical approach of the ovarian cancer, in early stage (Ia Ib, Ic) by International Federation of Gynecology and Obstetrics (FIGO). Studies of systematic revision, with focus on diagnosis, evaluated the accuracy of the ultrasonography with color Doppler, of CA 125 and the frozen section. Conclusion: The systematic review with therapeutic focus - laparoscopy versus laparotomy for ovarian cancer by FIGO stage I (Ia, Ib,Ic) did not find evidence to support the use of laparoscopy for the management of early stage ovarian cancer as routine clinical practice. Further studies with good quality are needed comparing laparoscopy surgery with laparotomy for the management of early stage ovarian cancer. As well as the importance of the correct classification of the study design for the authors, and for the reviewers of the papers, because we had two cohort studies incorrectly classified as being case-controls. A quantitative systematic review performed to estimate the diagnostic accuracy of frozen section conclude that diagnostic accuracy rates for frozen section analysis is high for malignant and benign ovarian tumors, but for borderline tumors they remain relatively low. A quantitative systematic review performed to estimate the accuracy ultrasonography with color Doppler is a useful pre-operative test for predicting the diagnosis of pelvic masses. Also, the quantitative systematic review performed to estimate the accuracy of CA 125 level ≥ 35 U/ml concluded that this is a useful pre-operative test for predicting the benign or malignant nature of a pelvic mass. In conclusion, these four studies of systematic reviews regarding the approach of ovarian tumors have shown low evidence levels laparoscopy in the early ovarian cancer ovarian (stage I by FIGO) and, also that the three diagnostic exams are really important in the presence of ovarian tumor, helping to define the diagnosis. Once the diagnostic is defined, it remains to adopt the better therapeutic option

Revisão sistemática com enfoque diagnóstico e terapêutico das tumorações ovarianas

Introdução: Em cirurgia ginecológica, o tratamento dos tumores ovarianos é tema que suscita inúmeras controvérsias quanto à melhor abordagem − se por laparoscopia ou por laparotomia. Entretanto, nos casos de neoplasia maligna de ovário, o manejo por essa via torna-se inadequado, em decorrência das pequenas incisões que dificultam os cuidados operatórios preconizados para essas neoplasias. Quando uma tumoração ovariana é detectada, faz-se necessário estabelecer suas características de benignidade ou malignidade, sendo que determinados exames, de certa forma, guiam a conduta terapêutica a ser adotada, apesar de não possuírem 100% de acurácia. Esses exames são a ultra-sonografia transvaginal com Doppler colorido, o marcador tumoral CA 125 e o exame anatomopatológico de congelação durante o ato cirúrgico. Devido às incertezas que suscitam controvérsias quanto à melhor abordagem inicial para o manejo operatório das tumorações ovarianas, se por laparoscopia ou por laparotomia, planejamos realizar estudos de revisão sistemática. A revisão sistemática com enfoque terapêutico, comparou laparoscopia e laparotomia, na abordagem cirúrgica do câncer ovariano, em seus estágios iniciais (Ia, Ib, Ic) pela Federação Internacional de Ginecologia e Obstetrícia (FIGO). Estudos de revisão sistemática, com enfoque diagnóstico, avaliaram a acurácia diagnóstica da ultra-sonografia com Doppler colorido, do CA 125 e do exame anatomo-patológico de congelação. Conclusão A revisão sistemática com enfoque terapêutico – laparoscopia versus laparotomia para câncer ovariano em estágio inicial (Ia, Ib,Ic) pela FIGO – não encontrou evidências que apóiem o uso da laparoscopia para o manejo inicial do câncer ovariano em seus estágios iniciais como rotina na prática clínica. Verifica-se a necessidade de estudos com boa qualidade metodológica comparando laparoscopia e laparotomia para o manejo cirúrgico inicial desses tipos de câncer.Assim como a importância da classificação correta do desenho clínico dos estudos observacionais tanto pelos autores, bem como pelos revisores dos periódicos, visto que tivemos 2 artigos de coorte classificados erroneamente como sendo de casos e controles. A revisão sistemática com enfoque diagnóstico do exame de anatomopatológico de congelação Conclui-se, assim, que a acurácia do exame de anatomopatológico de congelação é elevada no diagnóstico de tumores malignos e benignos, sendo baixa, porém, para as lesões com malignidade limítrofe. A revisão sistemática, com enfoque diagnóstico, da ultra-sonografia com Doppler é um exame pré-teste importante na predição da natureza da tumoração ovariana – se maligna ou benigna. A revisão sistemática com enfoque diagnóstico do CA 125 com nívell sérico ≥ 35 U/ml é importante, nas tumorações ovarianas, para predizer se a lesão ovariana é de natureza benigna ou maligna. Em síntese, estes quatros estudos de revisão sistemática que abordam as tumorações ovarianas, mostraram níveis de evidência baixo para abordagem laparoscópica no câncer ovariano estágios inicias (Ia, Ib e Ic) pela FIGO. E que os três exames diagnósticos mais realizados na presença de tumoração ovariana são extremamente importantes para definir o diagnóstico. Definindo-se o diagnóstico, cabe adotar a melhor opção terapêutica.Introduction: In gynecological surgery, the treatment of the ovarian tumors is theme that raises countless controversies with relationship to the best approach if for laparoscopy or for laparotomy. However, in the cases of malignancy of ovarian tumor, the handling for that road becomes inadequate, due to the small incisions that hinder the operative cares extolled for those neoplasias. When an ovarian tumor is detected, it is necessary to establish its characteristics of benignancy or malignancy, and certain exams, in a certain way, guide the therapeutic conduct to be adopted one, in spite of they do not possess 100% of accuracy. Those exams are the ultrasonography with color Doppler, CA 125 assay and accuracy of frozen section the diagnosis of ovarian tumors. Due to the uncertainties that raise controversies regarding the relationship of the best initial approach for the operative handling of the ovarian tumor, if laparoscopy or laparotomy, we planned to accomplish studies of systematic review. The systematic review with therapeutic focus, compared laparoscopy and laparotomy, in the surgical approach of the ovarian cancer, in early stage (Ia Ib, Ic) by International Federation of Gynecology and Obstetrics (FIGO). Studies of systematic revision, with focus on diagnosis, evaluated the accuracy of the ultrasonography with color Doppler, of CA 125 and the frozen section. Conclusion: The systematic review with therapeutic focus - laparoscopy versus laparotomy for ovarian cancer by FIGO stage I (Ia, Ib,Ic) did not find evidence to support the use of laparoscopy for the management of early stage ovarian cancer as routine clinical practice. Further studies with good quality are needed comparing laparoscopy surgery with laparotomy for the management of early stage ovarian cancer. As well as the importance of the correct classification of the study design for the authors, and for the reviewers of the papers, because we had two cohort studies incorrectly classified as being case-controls. A quantitative systematic review performed to estimate the diagnostic accuracy of frozen section conclude that diagnostic accuracy rates for frozen section analysis is high for malignant and benign ovarian tumors, but for borderline tumors they remain relatively low. A quantitative systematic review performed to estimate the accuracy ultrasonography with color Doppler is a useful pre-operative test for predicting the diagnosis of pelvic masses. Also, the quantitative systematic review performed to estimate the accuracy of CA 125 level ≥ 35 U/ml concluded that this is a useful pre-operative test for predicting the benign or malignant nature of a pelvic mass. In conclusion, these four studies of systematic reviews regarding the approach of ovarian tumors have shown low evidence levels laparoscopy in the early ovarian cancer ovarian (stage I by FIGO) and, also that the three diagnostic exams are really important in the presence of ovarian tumor, helping to define the diagnosis. Once the diagnostic is defined, it remains to adopt the better therapeutic option

Laparoscopia versus laparotomia nas tumorações ovarianas benignas

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Candidaemia and cancer : patients are not all the same

Background: Most of the studies about invasive Candida infections in cancer patients have focused on haematological patients. The aim of this study was to provide information about risk factors for candidaemia in patients with solid tumours. Methods: Retrospective cohort study. During a 9-year period (1995–2003) we reviewed all cases of candidaemia that affected cancer patients in Santa Casa Complexo Hospitalar, Brazil. Results: During the period of study, 210 patients had the diagnosis of candidaemia in our medical centre, and 83 of these patients had cancer (39.5%). The majority of patients with cancer had solid tumours (77.1%), mostly in the alimentary tract. Most of solid cancers were non-metastatic (71.9%). Major diagnoses in patients with haematological neoplasia were acute leukaemia (n = 13), high grade non-Hodgkin lymphoma (n = 5) and Hodgkin's disease (n = 1). Non-Candida albicans species caused 57.8% of the episodes of candidaemia in patients with cancer, mainly in patients with haematological malignancies (p = 0.034). Neutropenia and treatment with corticosteroids were more frequent in the haematological group, in comparison with patients with solid tumours. Only 22.2% of patients with solid tumours were neutropenic before candidaemia. Nonetheless, the presence of ileus and the use of anaerobicides were independent risk factors for candidaemia in patients with solid cancers The overall mortality in cancer patients with candidaemia was 49.4%. We then compared 2 groups of adult patients with candidaemia. The first was composed of non-neutropenic patients with solid tumours, and the second group included patients without cancer. We found that central venous catheters and gastrointestinal surgery were independently associated with candidaemia in patients with solid tumour. Conclusion: Cancer patients with candidaemia seem to have very different predisposing factors to acquire the infection when stratified according to baseline diseases. This study provides some useful clinical information regarding risk for candidaemia in patients with solid tumours

Expressão da P16INK4A e infecção pelo papiloma vírus humano (HPV) em lesões intraepiteliais cervicais e aspectos epidemiológicos

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Survival study of breast cancer patients treated at the hospital of the Federal University in Santa Maria, Rio Grande do Sul, Brazil

O objetivo deste estudo retrospectivo de base hospitalar foi descrever as condições de saúde e estimar a sobrevida de 252 pacientes, com diagnóstico prévio de câncer de mama, tratadas e acompanhadas no Ambulatório de Mastologia do Hospital Universitário de Santa Maria, Rio Grande do Sul, Brasil, no período de 1980 a 2000. Para a análise estatística foram utilizados o estimador de Kaplan-Meier e o modelo de Cox. A idade média das pacientes foi 54 anos, sendo que 73,4% apresentaram diagnóstico histológico de carcinoma ductal invasor, 63,9% não apresentaram comprometimento dos linfonodos regionais e 57,6% encontravamse no estadiamento clínico II. Ao final do estudo, 64,7% das mulheres estavam vivas e sem câncer de mama, e 5,1% morreram por outra causa. A sobrevida estimada em 5 anos, foi de 87,7%, sendo os fatores prognósticos associados: tamanho do tumor (RR = 12,03; > 5cm), comprometimento (RR = 3,08; N1) e número de linfonodos ressecados (RR = 4,66; Nenhum), receptor de estrógeno (RR = 0,34) e c-erbB-2 (RR = 2,51). Com base nos achados deste estudo, destaca-se a importância de ações intensivas de orientação para implementar o rastreamento do câncer de mama, levando a diagnósticos em estádios precoces dessa neoplasia.This retrospective hospital-based study aimed to describe health conditions and to estimate the survival of 252 patients diagnosed with breast cancer and treated at the Mastology Outpatient Clinic at the University Hospital of the Federal University in Santa Maria, Rio Grande do Sul, Brazil, from 1980 to 2000. Analysis followed the Kaplan-Meier and Cox model.Mean age was 54, and 73.4% of the patients had a histological diagnosis of invasive ductal carcinoma, 63.9% showed no lymph node involvement, and 57.6% were clinical stage II. At the end of the study, 64.7% were alive and free of breast cancer and 5.1% had died of other causes. Fiveyear survival was 87.7% for all women, and prognostic factors associated with survival were tumor size (HR = 12.03; > 5cm), lymph node involvement (HR = 3.08; N1) and number (HR = 4.66; None), and estrogen (HR = 0.34) and c-erbB-2 (HR = 2.51) receptors. Based on the results, intensive awareness-raising campaigns are vitally important for implementing breast cancer screening to achieve early diagnosis