[Impact of surgical access on staging of early borderline and invasive tumors of the ovary].
The objectives were to evaluate the impact of the surgical approach on the staging of borderline tumors and early-stage malignancies of the ovary. We retrospectively reviewed cases of borderline and invasive ovarian tumors stages Ia through Ic treated surgically between January 1, 1985 and December 31, 2001. We compared the rates of potentially harmful procedures according to the surgical approach. The quality of surgical staging was assessed by examining each required procedure and by determining a score. The influence of variables related to patient characteristics, preoperative workup, and initial surgery on staging quality was tested by univariate analysis. Variables independently associated with staging quality were entered in a logistic regression model. SPPS 7.5 and STATA 8 software was used for statistical tests. Of 118 patients with borderline tumors, 48 (41 %) underwent laparoscopic surgery, 54 (45 %) laparotomy, and 16 (14 %) laparoscopy converted to laparotomy. Surgery was conservative in 57 % of cases overall ; this proportion was significantly greater with laparoscopy than with laparotomy (p < 0.05) and in younger women (p < 0.001). Intraoperative tumor rupture occurred in 9 % of patients, with no significant difference across surgical approaches (p = 0.1). Bag extraction was used in 19 (40 %) of 48 laparoscopically treated patients. Staging was incomplete in 73 % of patients. By univariate analysis, bilateral adnexectomy and, to a lesser extent, age > 44 years, laparotomy, hysterectomy, and treatment after 1995 predicted at least partial staging. Factors independently associated with at least partial staging in the multivariate model were treatment after 1995, bilateral adnexectomy, and hysterectomy. Of 178 patients with invasive tumors, 34 underwent laparoscopic surgery, 114 laparotomy, and 30 conversion from laparoscopy to laparotomy. The laparotomy group was characterized by significantly older patient age and larger tumors, compared to the laparoscopy group. Staging was often inadequate after initial surgery, most notably with low rates of paraaortic lymphadenectomy (0 % in the laparoscopy group, 18 % in the laparotomy group, and 33 % in the conversion group). Staging is often less complete with laparoscopy than with laparotomy. In patients with invasive cancer, inadequate initial staging is common, most notably when laparoscopy is used. The surgeons training seems of major importance.
Desfeux
Patrice
P
Université Paris-Descartes, Faculté de médecine, Paris.
Chatellier
Gilles
G
Bats
Anne-Sophie
AS
Larousserie
Florence
F
Bensaid
Chérazade
C
Nos
Claude
C
Querleu
Denis
D
Blanc
Bernard
B
Lécuru
Fabrice
F
D000328:Adult; D000704:Analysis of Variance; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods* / Q000592:standards; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies