title: Laparoscopic findings during adnexal surgery in women with a history of nongynecologic malignancy.
abstract: OBJECTIVE
  To describe the results of laparoscopic management of adnexal masses in women with a history of nongynecologic malignancy.
  
  
  METHODS
  We conducted a retrospective review of 262 patients with history of prior nongynecologic malignancy who underwent laparoscopy for management of an adnexal mass between 1/1992 and 6/2004.
  
  
  RESULTS
  Median patient age at laparoscopy was 55 years (range, 20-91 years), and median BMI was 25 kg/m2 (range, 14-41 kg/m2). Of the 262 patients, 145 (55.3%) had prior abdominal/pelvic surgery. Prior cancer history included breast (202, 77.1%), lymphoma/leukemia (16, 6.1%), colorectal (8, 3.0%), lung (7, 2.7%), multiple myeloma (5, 1.9%), head/neck (5, 1.9%), genitourinary (5, 1.9%), upper gastrointestinal (4, 1.5%), and other (10, 3.8%). Median ovarian mass diameter measured on radiologic imaging was 3.8 cm (range, 0.2-13.5 cm); median CA-125 was 17.0 U/mL (range, 1-7000 U/mL). In all, 49 (18.7%) patients had malignancy identified at laparoscopy, with 30/49 (61.2%) diagnosed with metastatic malignancy to the ovary and 19/49 (38.8%) having a new primary ovarian malignancy. Median tumor diameter and CA-125 were significantly higher in women found to have a malignancy (4.7 vs. 3.7 cm, and 35 vs. 14 U/mL, respectively). Overall, conversion to laparotomy occurred in 34 (12.9%) cases. Twenty-one of 49 (42.9%) patients with malignancy were converted to laparotomy compared with 13/213 (6.1%) when benign disease was noted (P < 0.001).
  
  
  CONCLUSIONS
  Approximately 1 in 5 patients with a history of nongynecologic malignancy who were selected for laparoscopic management of an adnexal mass was found to have malignancy, with 60% being metastatic from other primaries. The majority of cases were managed laparoscopically even if malignancy was identified.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
authors.forename: Margrit M
authors.initials: MM
authors.lastname: Juretzka
authors.forename: Cimberly L
authors.initials: CL
authors.lastname: Crawford
authors.forename: Christine
authors.initials: C
authors.lastname: Lee
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilton
authors.forename: Samer
authors.initials: S
authors.lastname: Schuman
authors.forename: Dennis S
authors.initials: DS
authors.lastname: Chi
authors.forename: Yukio
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Richard R
authors.initials: RR
authors.lastname: Barakat
authors.forename: Nadeem R
authors.initials: NR
authors.lastname: Abu-Rustum
mesh_terms: D000290:Adnexa Uteri / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies