title: Is preoperative selection of patients with cystic adnexal masses essential for laparoscopic treatment?
abstract: OBJECTIVE
  To analyze indications for preoperative selection of patients with cystic adnexal masses to be treated by laparoscopic surgery.
  
  
  METHODS
  Retrospective analysis (Canadian Task Force classification II-2).
  
  
  METHODS
  University and military hospitals.
  
  
  METHODS
  Three hundred sixteen women with adnexal masses.
  
  
  METHODS
  Before laparoscopy, 214 patients underwent evaluation (size of adnexal mass, ultrasonographic image, CA 125, suspicious clinical diagnosis); in 102 women laparoscopies were performed without taking these factors into account.
  
  
  RESULTS
  In the first center 99% of women were treated by laparoscopic surgery. One (0.4%) tumor of low malignant potential detected by deferred biopsy was operated on. In the second center 98% of cases were performed laparoscopically. In 3.9% of women carcinomas were detected intraoperatively and were treated by laparotomy (p = 0.04).
  
  
  CONCLUSIONS
  Laparoscopy is appropriate management of cystic adnexal masses, with a very low risk of unintentionally operating an ovarian carcinoma if a thorough preoperative evaluation is conducted. Only in centers where surgeons have enough training to cope with ovarian cancer may this evaluation be deferred, since conversion to laparotomy should be considered a second therapeutic step, and not an incorrect indication for laparoscopy. In centers where surgeons have no such training, strict preoperative selection of patients is mandatory
authors.affiliation: Hospital de Cl'nicas Jossquare de San Mart'n, Argentina.
authors.forename: R A
authors.initials: RA
authors.lastname: Buquet
authors.forename: A R
authors.initials: AR
authors.lastname: Amato
authors.forename: G B
authors.initials: GB
authors.lastname: Huang
authors.forename: J
authors.initials: J
authors.lastname: Singla
authors.forename: J
authors.initials: J
authors.lastname: Ortiz
authors.forename: O C
authors.initials: OC
authors.lastname: Ortiz
mesh_terms: D000291:Adnexal Diseases / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D002272:Carcinoembryonic Antigen / Q000032:analysis; D003560:Cysts / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000601:surgery; D018579:Patient Selection; D012189:Retrospective Studies
chemical_list: D002272:Carcinoembryonic Antigen