[Borderline tumors and cancers of the ovary. Laparoscopic-surgical evaluation]

Benign cysts of the ovary can now be correctly treated with laparoscopic surgery, but it is difficult to confirm the benign nature of the suspected formation. Thus, the major risk of the laparoscopic surgery is the dramatic consequences in case of malignancy as reported in several cases in the literature. We conducted a survey to evaluate this risk.

A retrospective multicentric survey of laparoscopic procedures performed for a diagnosis of lesions of the annexes or cyst of the ovary was conducted. Forty-four centres reported a total of 7,122 laparoscopic procedures, including 5,307 in which laparoscopic surgery was performed. Laparoscopic treatment included puncture (21.3%), partial exeresis (51.3%) and complete exeresis (25.6%). Conversion to laparotomy was required in 20 cases (25.6%). A complementary surgical procedure was needed after the laparoscopic procedure within a delay of 78 days in 49 cases (58%). Laparoscopy was the only procedure used in 16% of the cases.

Pathology reports of the surgical specimen indicated malignant lesions of the ovary in 78/5, 307 cases (1.47%) including 60 borderline tumours and 18 cancers. Among these 78 cases, preoperative work-up and laparoscopy had led to a diagnosis of a benign lesion in 17 (21.8%). Among the 49 cases with secondary surgery, a more advanced FIGO (International Federation of Gynaecology-Obstetrics) stage was observed in 11 (i.e. 8.3% of the 78 malignant cases) compared with the initial assessment.

These findings demonstrate that it is not rare to discover the malignant nature of an ovarian tumour after initial laparoscopic treatment of a formation initially diagnosed as benign. Such accidents are the result of insufficient security in risk evaluation before laparoscopy. Whenever there is even a minimal risk of malignancy, laparotomy must be performed as the procedure of choice.