[Surgical management of adnexal tumors]

Concerning laparoscopy and tumor dissemination, we know from several multivariate analyses that at laparotomy, if the tumor is entirely and immediately removed, the puncture of a stage I ovarian cancer has no influence on the prognosis. In contrast the inadequate surgical management of an undiagnosed ovarian cancer may worsen the prognosis. The diagnosis is the key step. To be able to immediately and completely treat an ovarian cancer when managing an ovarian tumor surgically, Laparoscopic diagnosis is safe and reliable when used cautiously. The surgical diagnosis may and should probably be performed by laparoscopy whatever the ultrasonographic appearance of the tumor. Masses diagnosed as suspicious at surgery should be treated by immediate laparotomy, since the results of laparoscopic treatment of an ovarian cancer are not known. In young patients, conservative surgery is the main advantage of laparoscopy, and should be achieved in most benign masses. The recent progresses of in vitro fertilization should be taken into account when managing an ovarian tumor in a patient who wishes to become pregnant. Frozen sections are useful, when treating highly suspicious masses, allowing an immediate staging and avoiding the disadvantages of a second surgical procedure. Whenever a malignant tumor has been missed at laparoscopy, restaging is required and should be considered to be an oncologic emergency.