Introduction
Methods
Patients
Analysis of surgical procedures
Statistical analysis
Results
BOT patients and primary surgery
Primary approach via laparotomy | Primary laparoscopic approach | P | |||
---|---|---|---|---|---|
(n = 61) | (58.1%) | (n = 44) | (41.9%) | ||
Age, median (years)
|
59
|
47
|
0.006
a
| ||
range
|
13-85
|
16-86
| |||
≤40 | 10 | 16.4% | 16 | 36.4% |
0.023
c
|
41-55 | 18 | 29.5% | 16 | 36.4% | 0.528c
|
56-65 | 12 | 19.7% | 5 | 11.4% | 0.294c
|
>65 | 21 | 34.4% | 7 | 15.9% |
0.044
c
|
FIGO stage
| |||||
I A/B | 40 | 65.6% | 19 | 43.2% |
0.029
c
|
I C | 13 | 21.3% | 19 | 43.2% |
0.019
c
|
II A-C | 1 | 1.6% | 2 | 4.5% | 0.570c
|
III A/B | 3 | 4.9% | 3 | 6.8% | 0.693c
|
III C | 4 | 6.6% | 1 | 2.3% | 0.396c
|
IV | 0 | 0.0% | 0 | 0.0% | |
Histologic subtype
| |||||
serous | 27 | 44.3% | 32 | 72.7% |
0.005
c
|
seromucinous | 2 | 3.3% | 5 | 11.4% | 0.127c
|
mucinous | 30 | 49.2% | 6 | 13.6% |
< 0.001
c
|
endometrioid | 2 | 3.3% | 1 | 2.3% | 1.000c
|
Implants
| |||||
yes | 8 | 13.1% | 2 | 4.5% | 0.140b
|
- invasive
|
1
|
0
| |||
- non-invasive
|
7
|
2
| |||
no | 53 | 86.9% | 42 | 95.5% | |
Ascites
| |||||
none | 27 | 44.3% | 18 | 40.9% | 0.468b
|
< 500 ml | 22 | 36.1% | 11 | 25.0% | |
> 500 ml | 8 | 13.1% | 2 | 4.5% | |
unknown | 4 | 6.6% | 13 | 29.5% | |
CA 125
|
44.6
|
48.5
| 0.804a
| ||
range
|
2-2770
|
6-360
| |||
elevated | 27 | 44.3% | 16 | 36.4% | 0.594b
|
within normal limits | 24 | 39.3% | 11 | 25.0% | |
unknown | 10 | 16.4% | 17 | 38.6% | |
BMI, median
|
23,4
|
24.1
| 0.904a
| ||
range
|
17,7-43,0
|
18.6-35.3
|
17,7-43,0
| ||
< 19 | 3 | 4.9% | 1 | 2.3% | 0.677b
|
19-24 | 23 | 37.7% | 15 | 34.1% | |
24-30 | 19 | 31.1% | 11 | 25.0% | |
>30 | 8 | 13.1% | 2 | 4.5% | |
unknown | 8 | 13.1% | 15 | 34.1% | |
ASA, median
|
2
|
2
|
0.010
a
| ||
range
|
1-3
|
1-3
|
1-3
| ||
1 | 7 | 11.5% | 13 | 29.5% |
0.020
b
|
2 | 31 | 50.8% | 14 | 31.8% | |
3 | 9 | 14.8% | 3 | 6.8% | |
unknown | 14 | 23.0% | 14 | 31.8% |
Surgical morbidity
Primary approach via laparotomy | Primary laparoscopic approach | P | |||
---|---|---|---|---|---|
(n = 61) | (58.1%) | (n = 44) | (41.9%) | ||
Indication for surgery
| |||||
cystic ovarian lesion | 56 | 91.8% | 42 | 95.5% | |
- unsuspicious ovarian cyst
|
0
|
13
| |||
- cystic lesion of unknown dignity
|
48
|
29
| |||
- suspected ovarian cancer/ BOT
|
8
|
0
| |||
unexpected diagnosis during surgery for different reason | 5 | 8.2% | 2 | 4.5% | |
Conversion of laparoscopy to laparotomy
(reason for conversion)
| 14 | 31.8% | |||
intraoperative conditions | 11 | 78.6% | |||
- tumor growth pattern and tumor size
|
8
| ||||
- adhesions
|
3
| ||||
result of intraoperative histology | 3 | 21.4% | |||
Surgical procedures in primary and re-staging surgery
| |||||
fertility sparing surgery | 9 | 14.8% | 15 | 34.1% | |
non-fertility sparing surgery | 52 | 85.2% | 29 | 65.9% | |
omentectomy | 33 | 54.1% | 30 | 68.2% | |
appendectomy | 35 | 57.4% | 12 | 27.3% | |
peritoneal biopsies | 37 | 60.7% | 23 | 52.3% | |
cytology | 49 | 80.3% | 38 | 86.4% | |
sampling of lymph nodes or lymphonodectomy | 24 | 39.3% | 14 | 31.8% | |
- pelvic
|
19
|
13
| |||
- paraaortic
|
5
|
3
| |||
Surgical cytoreduction
| 0.333b
| ||||
complete | 54 | 88.5% | 36 | 81.8% | |
incomplete | 7 | 11.5% | 8 | 18.2% | |
Surgical staging
|
< 0.001
b
| ||||
- complete in primary surgery | 30 | 49.2% | 4 | 9.1% | |
- incomplete in primary surgery | 31 | 50.8% | 40 | 90.9% | |
- complete after re-staging surgery | 31 | 50.8 | 23 | 52.3 | |
- incomplete after re-staging | 30 | 49.2 | 21 | 47.7 | |
Intraoperative histology
|
< 0.001
b
| ||||
obtained | 51 | 83.6% | 15 | 34.1% | |
- intraoperative diagnosis of BOT
|
30
|
9
| |||
not obtained | 10 | 16.4% | 29 | 65.9% | |
Cyst rupture
|
0.038
b
| ||||
yes | 8 | 13.1% | 13 | 29.5% | |
no | 53 | 86.9% | 31 | 70.5% | |
Duration of surgery, median (min)
| 136 | 112 | 0.120a
| ||
range
|
50-405
|
47-350
| |||
Eks, median
| 0 | 0 | 0.088a
| ||
range
|
0-6
|
0-2
| |||
FFPs, median
| 0 | 0 | 0.342a
| ||
range
|
0-20
|
0-10
| |||
Hb preop, median (mg/dl)
| 13.4 | 13.6 | 0.662a
| ||
range
|
5.6-15.1
|
10.3-14.8
| |||
Hb postop, median (mg/dl)
| 10.9 | 11.9 |
0.006
a
| ||
range | 7.4-13.6 | 9.5-14.3 | |||
Days on ICU, median (days)
| 0 | 0 |
0.014
a
| ||
range
|
0-4
|
0-2
| |||
Primary inhospital stay, median (days)
| 9 | 5 |
< 0.001
a
| ||
range
|
5-19
|
0-19
|
Primary approach via laparotomy | Primary laparoscopic approach | P | All surgeries | ||||
---|---|---|---|---|---|---|---|
61 | 44 | 105 | |||||
Overall complications
| |||||||
No complications
|
43
|
70.5%
|
36
|
81.8%
| 0.185b
| 79 |
75.2%
|
Yes
|
18
|
29.5%
|
8
|
18.2%
| 26 |
24.8%
| |
Intraoperative complications
| |||||||
No complications
|
54
|
88.5%
|
44
|
100.0%
|
0.020
b
| 98 |
93.3%
|
Yes
|
7
|
11.5%
|
0
|
0.0%
| 7 |
6.7%
| |
Intraoperative transfusions
|
5
|
62.5%
|
0
|
5
|
62.5%
| ||
Cardiac arrest
|
1
|
12.5%
|
0
|
1
|
12.5%
| ||
Bladder lesions
|
1
|
12.5%
|
0
|
1
|
12.5%
| ||
Ureter lesions
|
0
|
0%
|
0
|
0
|
0%
| ||
Bowel lesions
|
0
|
0%
|
0
|
0
|
0%
| ||
Intraoperative splenic injury
|
1
|
12.5%
|
0
|
1
|
12.5%
| ||
Complications in total
|
8
|
100.0%
|
0
|
8
|
100.0%
| ||
Postoperative complications/morbidity
| |||||||
No complications
|
49
|
80.3%
|
36
|
81.8%
| 0.848b
| 85 |
81.0%
|
Yes
|
12
|
19.7%
|
8
|
18.2%
| 20 |
19.0%
| |
Postoperative transfusion
|
5
|
29.4%
|
1
|
8.3%
|
6
|
20.7%
| |
Postoperative hemorrhage
|
0
|
0%
|
0
|
0%
|
0
|
0%
| |
Blood glucose dysregulation
|
1
|
5.9%
|
0
|
0%
|
1
|
3.4%
| |
Fever >6 days after surgery
|
1
|
5.9%
|
2
|
16.7%
|
3
|
10.3%
| |
Wound infection
|
2
|
11.8%
|
2
|
16.7%
|
4
|
13.8%
| |
Delayed wound healing
|
1
|
5.9%
|
1
|
8.3%
|
2
|
6.9%
| |
Persistent lymphatic cysts
|
1
|
5.9%
|
0
|
0%
|
1
|
3.4%
| |
Circulatory dysregulation
|
1
|
5.9%
|
2
|
16.7%
|
3
|
10.3%
| |
Deep vein thrombosis
|
2
|
11.8%
|
0
|
0%
|
2
|
6.9%
| |
Pulmonary embolism
|
0
|
0%
|
0
|
0%
|
0
|
0%
| |
Acute renal failure
|
0
|
0%
|
1
|
8.3%
|
1
|
3.4%
| |
Urinary retention
|
1
|
5.9%
|
0
|
0%
|
1
|
3.4%
| |
Ileus
|
0
|
0%
|
1
|
8.3%
|
1
|
3.4%
| |
Pleural effusion
|
0
|
0%
|
1
|
8.3%
|
1
|
3.4%
| |
Pain syndrome
|
1
|
5.9%
|
0
|
0%
|
1
|
3.4%
| |
Re-Laparotomy
|
0
|
0%
|
2
|
16.7%
|
2
|
6.9%
| |
Complications in total
|
16
|
100.0%
|
13
|
100.0%
|
29
|
100.0%
|