Interpretation
This meta-analysis justifies comprehensive staging surgery in
early-stage EOC patients, given that 18.7% will ultimately be upstaged,
consequently influencing adjuvant treatment and prognosis. Although the
clinical benefits and implications regarding comprehensive staging or
restaging surgeries are well defined, it should be clear that these
procedures also carry significant risks for complications. Intra- and
postoperative complications occur in up to 15.8% of the patients,
including internal bleeding, injuries to the urinary tract or
intestines, infections, and complications of wound
healing40. Its long-term sequelae, such as lymphedema
caused by lymphadenectomy, manifest in over 30% of the patients, and
negatively influence the quality of life41,42. A
laparoscopic approach could reduce some of the surgical morbidity,
though further trials would be required before a definitive statement
can be made about the clinical value of laparoscopic
staging43–45.
While all staging surgery components were found to have upstaging value,
some contributed only in a limited amount. Conceptually, the benefits
have to outweigh the associated disadvantages of each component. Kleppe
et al. suggest omitting a systematic lymphadenectomy in grade I mucinous
EOC since the incidence of positive lymph nodes is low, and the
morbidity as a direct consequence of lymphadenectomy
high46. We could not perform an analysis in this
specific subgroup, as insufficient data of this patient group could be
extracted. Therefore, we were unable to corroborate this statement with
the group level data retrieved from the included studies. Previous
reports have estimated the lymphadenopathy risk in apparent stage I-II
mucinous EOC at 0.8%. In the Netherlands, lymph node assessment is
currently no longer a required part of the staging surgery in patients
with mucinous histology.