Intraoperative Rupture of the Ovarian Capsule in Early-Stage Ovarian Cancer: A Meta-analysis

Shayan Dioun; Jenny Wu; Ling Chen; Samantha Kaplan; Yongmei Huang; Alexander Melamed; Allison Gockley; Caryn M St Clair; June Y Hou; Ana I Tergas; Fady Khoury-Collado; Hiroko Machida; Mikio Mikami; Koji Matsuo; Dawn L Hershman; Jason D Wright

doi:10.1097/AOG.0000000000004455

Intraoperative Rupture of the Ovarian Capsule in Early-Stage Ovarian Cancer: A Meta-analysis

Obstet Gynecol. 2021 Aug 1;138(2):261-271. doi: 10.1097/AOG.0000000000004455.

Authors

Shayan Dioun¹, Jenny Wu, Ling Chen, Samantha Kaplan, Yongmei Huang, Alexander Melamed, Allison Gockley, Caryn M St Clair, June Y Hou, Ana I Tergas, Fady Khoury-Collado, Hiroko Machida, Mikio Mikami, Koji Matsuo, Dawn L Hershman, Jason D Wright

Affiliation

¹ Columbia University College of Physicians and Surgeons, New York, New York; Duke University Medical Center, Durham, North Carolina; the Herbert Irving Comprehensive Cancer Center, New York, New York; New York Presbyterian Hospital, New York, New York; the Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California.

PMID: 34237756
DOI: 10.1097/AOG.0000000000004455

Abstract

Objective: To examine the effects of intraoperative ovarian capsule rupture on progression-free survival and overall survival in women who are undergoing surgery for early-stage ovarian cancer.

Data sources: MEDLINE using PubMed, EMBASE (Elsevier), ClinicalTrials.gov, and Scopus (Elsevier) were searched from inception until August 11, 2020.

Methods of study selection: High-quality studies reporting survival outcomes comparing ovarian capsule rupture to no capsule rupture among patients with early-stage epithelial ovarian cancer who underwent surgical management were abstracted. Study quality was assessed with the Newcastle-Ottawa Scale, and studies with scores of at least 7 points were included.

Tabulation, integration, and results: The data were extracted independently by multiple observers. Random-effects models were used to pool associations and to analyze the association between ovarian capsule rupture and oncologic outcomes. Seventeen studies met all the criteria for inclusion in the meta-analysis. Twelve thousand seven hundred fifty-six (62.6%) patients did not have capsule rupture and had disease confined to the ovary on final pathology; 5,532 (33.7%) patients had intraoperative capsule rupture of an otherwise early-stage ovarian cancer. Patients with intraoperative capsule rupture had worse progression-free survival (hazard ratio [HR] 1.92, 95% CI 1.34-2.76, P<.001), with moderate heterogeneity (I2=41%, P=.07) when compared with those without capsule rupture. Pooled results from these studies showed a worse overall survival (HR 1.48, 95% CI 1.15-1.91, P=.003), with moderate heterogeneity (I2=53%, P=.02) when compared with patients without intraoperative capsule rupture. This remained significant in a series of sensitivity analyses.

Conclusion: This systematic review and meta-analysis of high-quality observational studies shows that intraoperative ovarian capsule rupture results in decreased progression-free survival and overall survival in women with early-stage ovarian cancer who are undergoing initial surgical management.

Systematic review registration: PROSPERO, CRD42021216561.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Disease Progression
Female
Humans
Intraoperative Complications*
Ovarian Neoplasms / mortality
Ovarian Neoplasms / surgery*
Ovary / injuries*
Progression-Free Survival*
Rupture*
Survival Rate