Are borderline tumors of the ovary safely treated by laparoscopy?
OBJECTIVE
To evaluate the risk of the laparoscopic approach to patients with borderline ovarian tumors compared to the laparotomic management.


METHODS
We treated or followed in our institution 479 women with borderline ovarian tumor. Sixty-two patients had fertility-sparing surgery followed by restaging or follow-up intervention: 30 operated by laparoscopy, 32 by laparotomy. Restaging surgery was performed in five cases and second-look surgery in 57.


RESULTS
The diameter of the cyst is significantly lower in patients treated by laparoscopy, especially in women who underwent cystectomy (4.7 cm) compared to oophorectomy (10 cm, P = 0.008). Rupture of the cyst and stage IC were more frequent in the laparoscopic group. After a median follow-up of 61 months for the laparoscopic group and 77 months for the laparotomic group, we observed 11 patients (37%) with persistent disease after primary laparoscopy (adnexa, five cases; peritoneal implants, three cases; both patterns, three cases). After primary laparotomy, no patients showed early persistence of tumor, and ovarian relapses were diagnosed in seven women (22%) 33-138 months after laparotomy. The univariate analysis for the risk of neoplastic persistence after primary laparoscopy shows that patients with cysts greater than 5 cm have a higher risk (odds ratio 9.7, P = 0.02) compared to smaller cysts. No other factors proved significant, but the odds ratios for patients with serous tumor (5.8), stage IC (2.0), and those undergoing cystectomy (1.9) suggest a relationship to the probability of persistence.


CONCLUSIONS
Laparoscopic treatment in borderline ovarian tumors should be reserved to masses not greater than 5 cm. When conservative therapy is desired, the entire affected ovary should be removed. If the neoplasia is bilateral, cystectomy could be allowed in women who wish to preserve fertility, although they are at high risk of relapse.
Maneo
Andrea
A
Department Obstetrics and Gynecology, S. Gerardo Hospital, University of Milano-Bicocca, via Solferino 16, 20052 Monza, Milan, Italy. a.maneo@hsgerardo.org
Vignali
Michele
M
Chiari
Stefania
S
Colombo
Andrea
A
Mangioni
Costantino
C
Landoni
Fabio
F
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010052:Ovariectomy