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Laparoscopic surgery for complex ovarian masses
U Ulrich1, W Paulus, A Schneider
1Department of Obstetrics and Gynecology, University of Bonn School of Medicine, Sigmund Freud Strasse 25, 53105 Bonn, Germany.
Study Objective:
To assess the value of laparoscopy in managing complex ovarian masses.
Design:
Retrospective, observational analysis (Canadian Task Force classification II-2).
Setting:
University-based, tertiary level center for endoscopic surgery.
Patients:
Two hundred eleven consecutive women.
Interventions:
Laparoscopic surgery including ovary-preserving surgery, salpingo-oophorectomy, adhesiolysis, and pelvic lymphadenectomy.
Measurements And Main Results:
Patients were selected on the basis of preoperative ultrasound findings. Intraoperative appearance of the tumors as well as results from frozen section examinations were compared with histologic results. Two hundred sixteen pelvic masses were benign. In 10 patients, early ovarian cancer, borderline tumors, tubal cancer, or secondary ovarian, nongynecologic pathology was managed primarily by laparoscopy and confirmed histologically. Three of these 10 women underwent standard radical open surgery within 1 week. The true nature of masses was not recognized at the time of laparoscopy in three patients with malignant findings. Patients with malignant tumors were followed for 5 years.
Conclusion:
Although most complex ovarian masses can be managed by laparoscopy, the possibility of overlooking malignancy remains, even with frozen section examination. Whether or not laparoscopy compromises clinical outcome compared with laparotomy is not fully understood. Prospective studies to address this important clinical question are urgently needed.