Strict Criteria for Selection of Laparoscopy for Women with Adnexal Mass

Abstract

Objectives:We compared the indication of laparoscopy for treatment of adnexal masses based on the risk scores and tumor diameters with the indication based on gynecology-oncologists' experience.Methods:This was a prospective study of 174 women who underwent surgery for adnexal tumors (116 laparotomies, 58 laparoscopies). The surgeries begun and completed by laparoscopy, with benign pathologic diagnosis, were considered successful. Laparoscopic surgeries that required conversion to laparotomy, led to a malignant diagnosis, or facilitated cyst rupture were considered failures. Two groups were defined for laparoscopy indication: (1) absence of American College of Obstetrics and Gynecology (ACOG) guideline for referral of high-risk adnexal masses criteria (ACOG negative) associated with 3 different tumor sizes (10, 12, and 14 cm); and (2) Index of Risk of Malignancy (IRM) with cutoffs at 100, 200, and 300, associated with the same 3 tumor sizes. Both groups were compared with the indication based on the surgeon's experience to verify whether the selection based on strict rules would improve the rate of successful laparoscopy.Results:ACOG-negative and tumors ≤10 cm and IRM with a cutoff at 300 points and tumors ≤10cm resulted in the same best performance (78% success = 38/49 laparoscopies). However, compared with the results of the gynecology-oncologists' experience, those were not statistically significant.Discussion:The selection of patients with adnexal mass to laparoscopy by the use of the ACOG guideline or IRM associated with tumor diameter had similar performance as the experience of gynecology-oncologists. Both methods are reproducible and easy to apply to all women with adnexal masses and could be used by general gynecologists to select women for laparoscopic surgery; however, referral to a gynecology-oncologist is advisable when there is any doubt.

Acute abdomen with adnexal masses in the reproductive age group: diagnosis and management

“…6,8 However as seen in this study and many other recent publications most cases of adnexal masses are managed with laparoscopy. 9,10 In a study on 174 women operated on for an adnexal mass (excluding pregnancy), surgeons selected 58 of those for laparoscopy. Forty (69%) laparoscopies were considered successful and 18 (31%) were considered failures.…”

“…Only tumor diameter >7 cm was associated with laparoscopy failure (OR, 10.3, 95% CI, 2.47-42.95, p<0.01). 9 In a study from Taiwan, among 42 women with adnexal torsion, laparoscopy was the preferred surgical mode in 27 women (64%). Laparoscopy resulted in lesser hospital stay.…”