Primary staging in ovarian tumors of low malignant potential

Surgical staging, consisting of peritoneal washings for cytology, infracolic omentectomy, and biopsies of diaphragm, extrapelvic peritoneum, and pelvic and aortic lymph nodes, was performed in 29 patients with ovarian tumors of low malignant potential, presumed to be either Stage I (25) or Stage II (4), in order to determine the incidence of unsuspected metastases in patients with localized disease. Fourteen patients had all and fifteen patients had one or more of these procedures performed. Overall, in stages I and II, positive peritoneal cytology was found in 7%, unexpected omental metastases in 13%, diaphragmatic metastases in 7%, positive pelvic lymph nodes in 27%, and positive aortic lymph nodes in 7%. Seven out of 29 (24%) patients with presumed localized disease, were upstaged by virtue of the staging procedures. Based on our findings, we conclude that surgical-pathologic staging to search for occult metastases in ovarian tumors of low malignant potential is justified from an investigational standpoint: however, its impact on therapeutic management is far from being defined.