Successful perioperative management for a giant ovarian tumor in older adults: A case report

Accurate preoperative assessment of physical function is vital for determining surgical indications and selecting appropriate procedures in older adults. In potentially malignant cases of giant ovarian tumors, tumor capsule intraoperative rupture can cause upstaging and increase malignant ovarian tumor recurrence risk; thus, avoiding it is essential.

An 81-year-old woman with a giant ovarian tumor underwent preoperative evaluation using the estimation of physiologic ability and surgical stress (E-PASS) scoring system and the FRAIL scale. Laparoscopy-assisted surgery was performed using the Aron alpha method, and postoperative management followed the enhanced recovery after surgery (ERAS) protocol, resulting in successful perioperative management without complications. The patient exhibited a 30 cm cystic mass in the ovary identified on abdominal computed tomography. Preoperative assessment using E-PASS and FRAIL Scale yielded a preoperative risk score, surgical stress score, and comprehensive risk score of 0.49, 0.41, and 0.53, respectively, corresponding to a 4.2% in-hospital mortality rate. The FRAIL scale indicated a state of frailty. Following an anesthesiology consultation on the overall condition and surgical feasibility, the Aron alpha method was performed. Postoperatively, ERAS-based management was implemented, and the patient was discharged on postoperative day 5. Activities of daily living or cognitive function remained unchanged.

Detailed preoperative evaluation and the Aron alpha method could assist older women with giant ovarian tumors, with suspected malignancy.