Management and outcome of borderline ovarian tumors incidentally discovered at or after laparoscopy

Abstract

Background. To evaluate in a series of patients with borderline ovarian tumors the clinical findings and the outcome after laparoscopic management. Methods. Retrospective study of 25 patients with borderline ovarian tumors first treated by laparoscopic approach. Results. Thirteen patients had mucinous tumors and 12 had serous tumors. Twenty-one patients had ultrasound examination which detected 24 ovarian cysts including multilocular cysts in 50% of cases and unilocular sonolucent cysts in 25% of cases. The serum CA 125 and CA 199 levels were elevated in 30.7% and 23% respectively. Among the 25 patients first treated by laparoscopic approach, 24 had stage I disease: six of them had cystectomy, seven unilateral salpingo-oophorectomy, two bilateral salpingo-oophorectomy and two laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Seven patients had laparoconversion for presumption of ovarian cancer (5) and failure of laparoscopic procedure (2). One patient with stage III disease had laparoscopic biopsies and subsequent laparotomy. Among the 25 patients, 15 had conservative treatment and 10 had radical treatment. Three recurrences occurred after cystectomy. The mean follow-up was 41 months. Twenty-three patients were alive without evidence of disease, one died of intercurrent disease and one patient was lost to follow-up. Conclusion. Our data suggest that the laparoscopic approach to borderline ovarian tumors is possible in early stage disease but associated with a high risk of recurrence after cystectomy.

Laparoscopic restaging of borderline ovarian tumors

“…These results are in keeping with those of previous studies and illustrate the difficulties of distinguishing true recurrences from tumor persistence in the absence of a restaging operation [19,31]. Tumor persistence probably contributes to the high recurrence rate of borderline tumors after conservative surgery [9,32].…”

“…Initial laparoscopic management of borderline ovarian tumors is an acceptable option [9,12,27]. On the basis of transvaginal sonography, serum tumor marker assay, and macroscopic features during surgery, only 38% of the women in the current study were recognized as potentially having malignant or borderline ovarian tumors and thus histologically examined intraoperatively.…”

“…Appendectomy also is recommended for women with mucinous borderline ovarian tumors [6]. However, findings have shown fertility-sparing surgery to be feasible and safe for young women [7][8][9][10][11][12][13]. The 5-year survival rate for women with stage I borderline tumors is 95% to 97% [14,15], compared with only 65% to 87% for women with stages II and III borderline tumors [1,2,7,15,16].…”

Chemotherapy of borderline ovarian tumors

“…Leur fréquence est fonction des modalités de la chirurgie initiale pour les petits stades (kystectomie simple, annexectomie unilatérale ou annexectomie bilatérale) [15,38,43,66] et du stade d'extension de la maladie [12]. Les données concernant l'impact de la nature des implants péritonéaux (invasifs ou non) sur la fréquence des récidives sont contradictoires.…”

Place de la chimiothérapie dans le traitement des tumeurs de l’ovaire à la limite de la malignité

“…Cependant, la détermination des patientes à haut risque nécessitant un traitement adjuvant reste problématique. Il n'y a pas d'impact indépendant sur la survie de l'envahissement ganglionnaire (31-33), des modalités de la chirurgie (conservatrice ou non) (13,14), de la rupture capsulaire (34,35), de l'existence de végétations exophytiques à la surface de l'ovaire (36), d'une micro-invasion stromale (37-39), de l'hyperexpression de la p53 (40) ou de Her-2/neu (41) ou de mutations de K-ras (4, 42).…”