Laparoscopic surgery for early ovarian cancer

consensus has been reached in regard to laparoscopic surgery as surgery for benign ovarian tumors, and it is being performed widely. However, there have been no comparative studies in regard to performing laparoscopic surgery for ovarian cancer that have been conducted by a randomized controlled study design. Research thus far has been limited to prospective and retrospective studies up to level III (evidence from case, correlation, and comparative studies), and we are still at the stage where laparoscopic surgery for ovarian cancer is being debated. Staging procedures, including hysterectomy, bilateral salingo-oophorectomy, omentectomy, peritoneal biopsies, retroperitoneal lymph node sampling from the pelvic and paraaortic regions, and maximal debulking, are considered important in surgery for ovarian cancer. In the past the staging procedures were performed by open surgery, but in 1990 Reich et al. [1] became the first to report a case of laparoscopic surgery for stage I ovarian cancer, and in 1994 Querleu and LeBlanc et al. [2] performed laparoscopic surgery in a series of 9 cases of ovarian cancer and fallopian tube cancer and assessed the feasibility of laparoscopic paraaortic lymphad-enectomy. These reports have been followed by many reports on the feasibility and efficacy of laparoscopic surgery in the treatment of early ovarian cancer [3-5]. The benefits of laparoscopic surgery for ovarian cancer are said to be that it is less invasive than open surgery, and, more specifically, that there is no abdominal decompression procedure, that there is little blood loss, that the wound site is small and there is little postoperative pain, and that the length of hospital stay is short [6-8]. On the other hand, there are also several disadvantages. One disadvantage concerns whether surgical staging is done properly, and there is a report of a study that compared laparoscopic surgery and open surgery as a means of staging evaluation on the basis of the numbers of retroperitoneal lymph nodes that were excised [4]. The second disadvantage is the existence of the problem of the risk of port site metastasis. The incidence of port site metastasis has varied from report to report, but many reports state that the risk of port site metastasis is higher in advanced ovarian cancer complicated by carcinomatous peritonitis and ascites and in recurrent ovarian cancer [9,10]. Zivanovic et al. [11] reported an incidence of recurrence at the port site alone of 0.1%. Thus, if restricted to early ovarian cancer, the risk of port …