[Diagnosis and therapy of adnexal tumors in postmenopause. A prospective study]

The management of postmenopausal adnexal tumours is still controversially discussed. Approximately 30% of all postmenopausal tumours are malignant. The standard operative approach for these adnexal masses is still the exploratory laparotomy although the advantages of laparoscopic procedure are obvious, even in older patients. The aim of this prospective study was to find out to what extent diagnostic-operative laparoscopy is able to replace laparotomy in the therapy of postmenopausal adnexal masses. From January 1990 to August 1992, 169 postmenopausal patients entered the prospective study. After careful preoperative diagnostics, 63 patients underwent a laparotomy (group B) and 106 patients a laparoscopy (group A). 10 of these 106 cases underwent laparotomy after diagnostic laparoscopy (group Ab). The main operative procedure in group Aa was laparoscopic adnexectomy after Semm. Mean operative time and mean postoperative hospital stay were significantly lower in patients, who only underwent laparoscopic operation (group Aa). One case (0.9%) of the laparoscopically operated patients was subsequently found to be malignant (histologic assessment) and immediately treated by laparotomy with hysterectomy and contralateral adnexectomy. The combination of vaginal examination, vaginal/abdominal ultrasonography (tumor marker CA 125) and a sufficient preoperative diagnostic during endosurgery (no proliferations on the ovary or peritoneal surface, no ascites) reduces the risk of operating a malignant tumour by laparoscopy to a minimum. We believe that operative laparoscopy of postmenopausal adnexal masses is a safe and efficient method in carefully selected women.