Research
Oncology
Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome

Presented at the 39th Annual Meeting on Women's Cancer by the Society of Gynecologic Oncologists, Tampa, FL, March 9-12, 2008.
https://doi.org/10.1016/j.ajog.2008.08.013Get rights and content

Objective

To evaluate the role of laparoscopy for staging of early ovarian cancers.

Study Design

Case series conducted at the University Hospital with 36 patients who had presumed early-stage adnexal cancers. Laparoscopic staging/restaging was performed.

Results

Cases included 20 invasive epithelial tumors, 11 borderline tumors, and 5 nonepithelial tumors. Mean number of peritoneal biopsies, paraaortic nodes, and pelvic nodes were 6, 12.23, and 14.84, respectively. Eighty-three percent of the patients had laparoscopic omentectomy. On final pathology, 7 patients were upstaged. Postoperative complications included 1 small bowel obstruction, 2 pelvic lymphoceles, and 1 lymphocele cyst. Mean duration of follow-up is 55.9 months. Three patients had recurrences. All patients are alive without evidence of the disease.

Conclusion

This represents 1 of the largest series and longest follow-ups of laparoscopic staging for early-stage adnexal tumors. Laparoscopic staging of these cancers appears to be feasible and comprehensive without compromising survival when performed by gynecologic oncologists experienced with advanced laparoscopy.

Section snippets

Materials and Methods

A 12-year retrospective review of laparoscopic staging procedures for early-stage ovarian and fallopian tube cancers from 1995-2007 performed by the Gynecologic Oncology Division at Mount Sinai Medical Center was conducted. Pathology and operative reports, as well as chemotherapy and hospital charts, were examined with institutional review board approval. All patients were thoroughly counseled preoperatively about the procedure and appropriate informed consent was obtained. The technique of

Results

A total of 36 patients underwent laparoscopic staging for presumed stage I ovarian or fallopian tube cancer. Patients characteristics are outlined in Table 1. Mean age of the patients was 47.8 years (range, 17-89 years), with 27 patients presenting with an adnexal mass and 9 patients who were referred for restaging after undergoing cystectomy or salpingo-oophorectomy with findings of an occult cancer on final pathology; 2 patients had received neoadjuvant chemotherapy before the end-staging

Comment

The first case series of adnexal malignancies (tubal and ovarian) being managed laparoscopically was reported by Querleu and LeBlanc in 1994.11 After this initial report, other authors have described their experience in similar publications confirming the feasibility and efficacy of laparoscopy in the management of early ovarian and tubal neoplasms.12, 13, 14, 15, 16, 17, 18, 19, 20 However, this approach has been the subject of a considerable debate since its introduction into medical practice

Conclusion

This represents one of the largest series and longest follow-ups of laparoscopic staging for presumed early-stage ovarian and fallopian tube cancers. Laparoscopic staging of these cancers appears to be feasible, comprehensive, and safe when performed by gynecologic oncologists experienced in advanced operative laparoscopy. The advantages of laparoscopic surgery include shorter hospital stay, more rapid resumption of normal activities, comparable length of surgery, and similar complication rate

References (41)

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Cite this article as: Nezhat FR, Ezzati M, Chuang L, et al. Laparoscopic management of early ovarian and fallopian tube cancers: surgical and survival outcome. Am J Obstet Gynecol 2009;200:83.e1-83.e6.

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