Laparoscopic restaging of borderline ovarian tumours: results of 30 cases initially presumed as stage IA borderline ovarian tumours

Abstract

Objectives To review our experience with the laparoscopic restaging procedure of presumed early stage borderline ovarian tumours. Design Retrospective study.Setting Cancer centre.Population Thirty patients with presumed stage I borderline ovarian tumours after limited initial surgery.Methods From April 1991 to May 2001, the patients were laparoscopically reassessed. The procedure involved peritoneal cytology, exploration of the peritoneal cavity, infracolic omentectomy, directed or random peritoneal biopsies, and when appropriate, contralateral oophorectomy and hysterectomy and appendectomy. Medical records were reviewed for patients' age, interval time between procedures, tumour stage, histological type, operative time, hospital stay, peri-operative complications and follow up. Main outcome measures Seroperative and postoperative data, pathology and clinical follow up.Results Laparoscopic restaging was completed in all 30 (100%) identified patients. The mean age was 34.8 (10.5) years; the delay between initial operation and restaging laparoscopy averaged 9.8 (6.6) weeks. The mean operative time was 165.4 (53.8) minutes, and the mean hospital stay was 2.7 (1.3) days. There were two (7.0%) major complications related directly to the procedure. Eight (26.6%) patients were upstaged. Mean follow up was 29.1 (6.6) months, all patients are alive and one (3.2%) recurrence was observed. Conclusions Laparoscopic approach of restaging for borderline ovarian tumours is an accurate safe procedure.It is associated with an acceptable rate of minor complications, it has similar morbidity associated with laparotomy and it minimises the incidence of infertility in the young patients. Whenever staging of borderline ovarian tumours is to be considered in an individual patient, laparoscopy provides a suitable alternative approach.

Laparoscopic restaging of borderline ovarian tumors

“…These data are in full agreement with those of the only previous study to focus on laparoscopic restaging, in which Querleu et al [26] demonstrated its feasibility and acceptable morbidity rate.…”

“…In our study, 16.6% of the women who underwent surgical restaging were upstaged, in keeping with previous reports (12-47%) [22][23][24][25][26]. Restaging had an impact on 21.4% of the women, including women with tumor persistence.…”

“…Although restaging operations led to upstaging in up to 47% of cases in previous studies, the risk-benefit balance must be carefully weighed, especially when laparotomy is required [21][22][23][24][25]. Recently, Querleu et al [26] demonstrated the feasibility of laparoscopic restaging, reporting an upstaging rate of 26.6% and minimal perioperative morbidity.…”

Defining the surgical management of suspected early‐stage ovarian cancer by estimating patient numbers through alternative management strategies

“…Furthermore, this strategy would result in most cases with borderline ovarian tumours and a very small number with benign tumours having systematic node dissection, and as there is no difference in recurrence or survival rate of patients with borderline ovarian tumours and nodal metastases, [30][31][32] it is generally considered that lymphadenectomy can be safely omitted in these patients. 33 However, the advantage of this strategy is that more cancer cases are identified at the time of surgery: cancer cases identified postoperatively on final histopathology that are not offered chemotherapy on the basis of high risk grade, stage or type, must choose between a second staging procedure 34,35 or accepting chemotherapy on the basis that lymph node metastases have not been excluded.…”

A borderline mucinous ovarian tumour treated by ovarian cystectomy in a 16-year-old patient

“…Borderline ovarian tumours, described in 1929 by Taylor [1], consist of a subgroup of ovarian tumours characterised by the presence of branching papillae, epithelial stratification, nuclear atypia, mitotic activity, and the absence of stromal invasion in the primary tumour [2]. These ovarian tumours comprise 7.5-15% of all epithelial ovarian neoplasms.…”