Predictors of clinical outcomes in the laparoscopic management of adnexal masses.
OBJECTIVE
Laparoscopy has become an accepted approach in the management of adnexal masses. We evaluated clinical outcomes of laparoscopic management of adnexal masses thought to be benign preoperatively.


METHODS
We performed a retrospective study of patients undergoing laparoscopic evaluation of adnexal masses over a 7-year period. Regression models evaluated predictors of blood loss, length of stay, complications, mass rupture, conversion to laparotomy, and operating time. Preoperative predictors of malignant and borderline disease were evaluated using a separate model.


RESULTS
Complications occurred in 8% of 396 patients undergoing laparoscopic evaluation of adnexal masses and were associated with concurrent hysterectomy (P =.01) and smaller mass (P =.01). Conversion to laparotomy occurred in 25% and was associated with larger mass (P =.001), prior hysterectomy (P =.002), and younger age (P =.002). Mass rupture occurred in 25% and was associated with prior (P <.001) or concurrent (P =.003) hysterectomy and younger age (P =.001). Blood loss greater than 500 mL was associated with concurrent hysterectomy (P <.001). Length of stay was associated with concurrent (P <.001) and prior (P <.001) hysterectomy, larger mass (P =.01), prior abdominal surgery (P =.009), and medical comorbidities (P =.007). Malignancy occurred in 2%, and laparoscopic management was not associated with adverse outcomes.


CONCLUSIONS
Adnexal masses thought to be benign preoperatively were successfully managed laparoscopically in three fourths of cases and clinical outcomes were acceptable. To a great extent, adverse events were attributable to concurrent hysterectomy rather than removal of the adnexal mass.
Havrilesky
Laura J
LJ
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, USA.
Peterson
Bercedis L
BL
Dryden
Damla K
DK
Soper
John T
JT
Clarke-Pearson
Daniel L
DL
Berchuck
Andrew
A
D000291:Adnexal Diseases / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002648:Child; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome