Surgical staging of early invasive epithelial ovarian tumors

Abstract

Early stage epithelial ovarian carcinoma is defined pathologically as a tumor strictly limited to one or both ovaries without any extra‐ovarian disease (i.e., Stage IA or B of the International Federation of Gynecology and Obstetrics (FIGO) classification). This diagnosis can be obtained only after an exhaustive surgical staging procedure, performed as soon as the diagnosis of epithelial invasive ovarian carcinoma is established. This staging surgery currently encompasses a peritoneal cytology, the thorough inspection of all the visceral and parietal peritoneal surfaces with biopsy of any abnormality, total abdominal hysterectomy and bilateral salpingo‐oophorectomy (TAH + BSO), random peritoneal biopsies, omentectomy, appendectomy and bilateral pelvic and para‐aortic lymphadenectomies, up to the left renal vein. The results of this staging procedure and its indications are discussed. In all of the cases, the radical removal of the pathologic adnexa is indicated, along with the complete peritoneal and retroperitoneal staging. While fertility‐sparing surgery (avoiding hysterectomy and contralateral adnexectomy, if possible) seems to be safe for young women, a TAH + BSO is the rule for the others. Adjuvant chemotherapy can be omitted in well‐differentiated tumors with a negative staging operation, but currently it remains indicated in all other cases. Indeed, the ultimate goal in early stage ovarian carcinoma is to not impair by inadequate management the high chance of a cure. Semin. Surg. Oncol. 19:36–41, 2000. © 2000 Wiley‐Liss, Inc.

Impact of initial surgical access on staging and survival of patients with stage I ovarian cancer

“…Nineteen percent of patients were upstaged, a rate similar to those published in studies on laparotomy (11,12) . Recurrence rate for stage IA and IB, grade 1 and 2 patients, was of 6.4%, also within published outcomes (median follow-up 54 months) (1,2) . Tozzi et al has reported results on 24 patients laparoscopically treated (n ¼ 13) or restaged (n ¼ 11) (7) .…”

“…Mean operating time was nearly 4 h, and serious complications occurred in two (7%) patients. After a mean follow-up of 38 months, among the 23 patients with negative lymph nodes at staging, only 1 had had a recurrence (2) . These authors have recently actualized their experience by publishing results of 53 patients treated within a 10-year period (8) .…”

Impact of initial surgical access on staging and survival of patients with stage I ovarian cancer

“…Nineteen percent of patients were upstaged, a rate similar to those published in studies on laparotomy (11,12) . Recurrence rate for stage IA and IB, grade 1 and 2 patients, was of 6.4%, also within published outcomes (median follow-up 54 months) (1,2) . Tozzi et al has reported results on 24 patients laparoscopically treated (n ¼ 13) or restaged (n ¼ 11) (7) .…”

“…Mean operating time was nearly 4 h, and serious complications occurred in two (7%) patients. After a mean follow-up of 38 months, among the 23 patients with negative lymph nodes at staging, only 1 had had a recurrence (2) . These authors have recently actualized their experience by publishing results of 53 patients treated within a 10-year period (8) .…”

Feasibility and efficacy of laparoscopic management of ovarian cancer

“…In case of poorly differentiated or clear cell carcinomas, in which unfavorable histology has been determined, the potential risk of recurrence can be reduced by removing any probable sites of late recurrence such as the lymph nodes, although the results do not alter the indication for adjuvant chemotherapy. 2 Lymphadenectomy may also have a therapeutic benefit by removing lymph nodes, which could potentially be resistant to chemotherapy. 20 If the frozen section analysis of the initial surgery appears negative or is not undertaken, the staging surgery is delayed; when the staging surgery takes place 17 days after the initial surgery, the risk of upstaging increases.…”

“…Unnecessary chemotherapy can thus be avoided. In case of poorly differentiated or clear cell carcinomas, in which unfavorable histology has been determined, the potential risk of recurrence can be reduced by removing any probable sites of late recurrence such as the lymph nodes, although the results do not alter the indication for adjuvant chemotherapy 2 . Lymphadenectomy may also have a therapeutic benefit by removing lymph nodes, which could potentially be resistant to chemotherapy 20 .…”

Prise en charge des masses annexielles organiques : résultats d’une enquête de pratique

“…Les stadifications des tumeurs frontières et malignes sont également insuffisantes et l'on peut regretter les 8 % de rupture accidentelle de tumeurs malignes [22]. Toutes les recommandations insistent sur la nécessité de cette stadification [4,[23][24][25]. Cette observation est d'autant plus surprenante que les opérateurs avaient une bonne appréciation du risque de malignité.…”

Impact of initial surgical access on staging and survival of patients with stage I ovarian cancer

“…Nineteen percent of patients were upstaged, a rate similar to those published in studies on laparotomy (11,12) . Recurrence rate for stage IA and IB, grade 1 and 2 patients, was of 6.4%, also within published outcomes (median follow-up 54 months) (1,2) . Tozzi et al has reported results on 24 patients laparoscopically treated (n ¼ 13) or restaged (n ¼ 11) (7) .…”

“…Mean operating time was nearly 4 h, and serious complications occurred in two (7%) patients. After a mean follow-up of 38 months, among the 23 patients with negative lymph nodes at staging, only 1 had had a recurrence (2) . These authors have recently actualized their experience by publishing results of 53 patients treated within a 10-year period (8) .…”

Feasibility and efficacy of laparoscopic management of ovarian cancer

“…In case of poorly differentiated or clear cell carcinomas, in which unfavorable histology has been determined, the potential risk of recurrence can be reduced by removing any probable sites of late recurrence such as the lymph nodes, although the results do not alter the indication for adjuvant chemotherapy. 2 Lymphadenectomy may also have a therapeutic benefit by removing lymph nodes, which could potentially be resistant to chemotherapy. 20 If the frozen section analysis of the initial surgery appears negative or is not undertaken, the staging surgery is delayed; when the staging surgery takes place 17 days after the initial surgery, the risk of upstaging increases.…”

“…Unnecessary chemotherapy can thus be avoided. In case of poorly differentiated or clear cell carcinomas, in which unfavorable histology has been determined, the potential risk of recurrence can be reduced by removing any probable sites of late recurrence such as the lymph nodes, although the results do not alter the indication for adjuvant chemotherapy 2 . Lymphadenectomy may also have a therapeutic benefit by removing lymph nodes, which could potentially be resistant to chemotherapy 20 .…”

Prise en charge des masses annexielles organiques : résultats d’une enquête de pratique

“…Les stadifications des tumeurs frontières et malignes sont également insuffisantes et l'on peut regretter les 8 % de rupture accidentelle de tumeurs malignes [22]. Toutes les recommandations insistent sur la nécessité de cette stadification [4,[23][24][25]. Cette observation est d'autant plus surprenante que les opérateurs avaient une bonne appréciation du risque de malignité.…”

Impact of initial surgical access on staging and survival of patients with stage I ovarian cancer

“…Nineteen percent of patients were upstaged, a rate similar to those published in studies on laparotomy (11,12) . Recurrence rate for stage IA and IB, grade 1 and 2 patients, was of 6.4%, also within published outcomes (median follow-up 54 months) (1,2) . Tozzi et al has reported results on 24 patients laparoscopically treated (n ¼ 13) or restaged (n ¼ 11) (7) .…”

“…Mean operating time was nearly 4 h, and serious complications occurred in two (7%) patients. After a mean follow-up of 38 months, among the 23 patients with negative lymph nodes at staging, only 1 had had a recurrence (2) . These authors have recently actualized their experience by publishing results of 53 patients treated within a 10-year period (8) .…”

Feasibility and efficacy of laparoscopic management of ovarian cancer

“…In case of poorly differentiated or clear cell carcinomas, in which unfavorable histology has been determined, the potential risk of recurrence can be reduced by removing any probable sites of late recurrence such as the lymph nodes, although the results do not alter the indication for adjuvant chemotherapy. 2 Lymphadenectomy may also have a therapeutic benefit by removing lymph nodes, which could potentially be resistant to chemotherapy. 20 If the frozen section analysis of the initial surgery appears negative or is not undertaken, the staging surgery is delayed; when the staging surgery takes place 17 days after the initial surgery, the risk of upstaging increases.…”

“…Unnecessary chemotherapy can thus be avoided. In case of poorly differentiated or clear cell carcinomas, in which unfavorable histology has been determined, the potential risk of recurrence can be reduced by removing any probable sites of late recurrence such as the lymph nodes, although the results do not alter the indication for adjuvant chemotherapy 2 . Lymphadenectomy may also have a therapeutic benefit by removing lymph nodes, which could potentially be resistant to chemotherapy 20 .…”

Prise en charge des masses annexielles organiques : résultats d’une enquête de pratique

“…Les stadifications des tumeurs frontières et malignes sont également insuffisantes et l'on peut regretter les 8 % de rupture accidentelle de tumeurs malignes [22]. Toutes les recommandations insistent sur la nécessité de cette stadification [4,[23][24][25]. Cette observation est d'autant plus surprenante que les opérateurs avaient une bonne appréciation du risque de malignité.…”