ObjectiveTo report a case of port-site metastasis (PSM) after laparoscopic treatment for borderline ovarian tumor (BOT), and to discuss the safety and efficacy of laparoscopic treatment for BOT as well as whether chemotherapy is beneficial for BOT patients. MethodsWe retrospectively studied a case of PSM after laparoscopic treatment of a micropapillary borderline ovarian tumor in August 2013, and reviewed the related literatures in PubMed and Cochrane databases from 1929 to 2014 using "port-site metastasis", "borderline ovarian tumor" , "laparoscopy" , "chemotherapy" as the subject words. ResultsAfter conservative operation and chemotherapy of "carboplatin and taxol" for 8 times, the subcutaneous nodes didn't shrink and the level of CA125 didn't reduce. Though some studies supported that laparoscopy was safe and effective for early-stage ovarian cancer and BOT, there was no high-quality evidence to help quantify the risks and benefits of laparoscopy for the management of early-stage ovarian cancer as routine clinical practice. While early researches suggested adjunctive chemotherapy benefited BOT patients, the subsequent studies indicated opposite results. Therefore, it was still controversial and a lack of high quality evidence existed. However, chemotherapy was recommended for those with high risks. ConclusionLaparotomy is still the standard treatment for ovarian tumor. For patients with low risks and requiring minimally invasive therapy, laparoscopy is an alternative choice, but it should be staged completely. For those with high risks or laparoscopy is difficult to perform, it should be converted to laparotomy as soon as possible. All these procedures should be completed by experienced and skillful gynecologic oncologists. For those with high risks, it is recommended that they should receive chemotherapy and be followed up for a long time.
ObjectiveTo systematically review the effect of laparoscopy versus laparotomy for borderline ovarian tumors (BOTs) on postoperative recurrence. MethodsWe searched PubMed, The Cochrane Library (Issue 11, 2015), EMbase, Web of Science, CNKI, WanFang Data and CBM databases from inception to Nov. 2015, to collect relevant clinical studies comparing laparoscopy and laparotomy for BOTs. Two reviewer independently screened literature, extracted data and assessed the risk of bias of include studies by using NOS scale. Then, meta-analysis was performed by using RevMan 5.3 software. ResultsNineteen cohort studies were included. The scores of NOS scale showed that 10 studies were < 7 points, while the other 9 studies were≥7 points. The results of meta-analysis showed that: the recurrence rate of tumor (OR=1.75, 95%CI 1.05 to 2.91, P=0.03) in the laparoscopy group was higher than that in the laparotomy group, but no significant differences were found in further subgroup analysis according to type of operations (conservative surgery: OR=1.22, 95%CI 0.71 to 2.08, P=0.47; non-conservative surgery: OR=4.38, 95% CI 0.85 to 22.68, P=0.08). The diameter of tumor in the laparoscopy group was significant smaller than that in the laparotomy group (MD=-6.88, 95% CI-8.15 to-5.61, P < 0.000 01), and the rate of rupture of tumor in the laparoscopy group was significant higher than that in the laparotomy group (OR=3.99, 95% CI 2.54 to 6.26, P < 0.000 01). ConclusionCurrent evidence shows, compared with laparotomy, laparoscopy has similar effect on postoperative recurrence and smaller diameter of tumor, but laparoscopy could increase the rate of rupture of tumor. Due to the limited quality and sample size of included studies, more high quality and large sample size studies are need to prove the above conclusion.