Preoperative and intraoperative evaluation in ovarian malignancy

The survival rate for patients with all stages of ovarian cancer has not improved over the past quarter of a century. A review of 100 consecutive patients treated for ovarian cancer was undertaken to evaluate preoperative and intraoperative measures. The study revealed that one-third of patients has only physical examination, other than routine preoperative tests, prior to laparotomy, and that 11% did not have a pelvic examination. Eighty-three percent of the incisions were inadequate for evaluation of the upper abdomen for sites of other primary malignancies that could metastasize to the ovary and mimic ovavian cancer, or for evaluating known sites of metastasis from ovarian cancer such as the diaphragm, liver, and upper aortic lymph nodes. Specifically, the aortic nodes were not described in 92% of reports, the diaphragm in 84%, the stomach in 76%, the pancreas in 76%, the colon in 70%, and the liver in 59%. The ovary was not resected or biopsied for histologic confirmation in one-third of the cases. It is proposed that the efficacious use of adjuvant therapy for women with ovarian cancer must be preceded by careful preoperative and intraoperative evaluation of all women with presumed ovarian malignancy.