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Published on: January 22, 2022
Is preoperative selection of patients with cystic adnexal masses essential for laparoscopic treatment?
R A Buquet1, A R Amato, G B Huang
1Hospital de Cl'nicas Jossquare de San Mart'n, Argentina.
Study Objective:
To analyze indications for preoperative selection of patients with cystic adnexal masses to be treated by laparoscopic surgery.
Design:
Retrospective analysis (Canadian Task Force classification II-2).
Setting:
University and military hospitals.
Patients:
Three hundred sixteen women with adnexal masses.
Intervention:
Before laparoscopy, 214 patients underwent evaluation (size of adnexal mass, ultrasonographic image, CA 125, suspicious clinical diagnosis); in 102 women laparoscopies were performed without taking these factors into account.
Measurements And Main Results:
In the first center 99% of women were treated by laparoscopic surgery. One (0.4%) tumor of low malignant potential detected by deferred biopsy was operated on. In the second center 98% of cases were performed laparoscopically. In 3.9% of women carcinomas were detected intraoperatively and were treated by laparotomy (p = 0.04).
Conclusion:
Laparoscopy is appropriate management of cystic adnexal masses, with a very low risk of unintentionally operating an ovarian carcinoma if a thorough preoperative evaluation is conducted. Only in centers where surgeons have enough training to cope with ovarian cancer may this evaluation be deferred, since conversion to laparotomy should be considered a second therapeutic step, and not an incorrect indication for laparoscopy. In centers where surgeons have no such training, strict preoperative selection of patients is mandatory
