Laparoscopic fertility-sparing staging in unexpected early stage ovarian malignancies.
OBJECTIVE
To assess feasibility and safety of fertility-sparing laparoscopic staging in women affected by unexpected ovarian cancer desiring to preserve their fertility.


METHODS
Prospective study.


METHODS
University clinic.


METHODS
Twenty-seven patients already operated on elsewhere for a presumably benign ovarian cyst.


METHODS
Laparoscopic fertility-sparing staging operations.


METHODS
Perioperative and survival data, reproductive outcome.


RESULTS
Histologic findings after first surgery: 12 low malignant potential neoplasms, 11 invasive epithelial ovarian carcinomas,1 sex-cord stromal, and 3 germ cell neoplasms. Fertility-sparing staging consisted of exploration of the peritoneal cavity, peritoneal washing cytology, multiple peritoneal biopsies, omolateral adnexectomy (except in borderline tumors), omentectomy, omolateral or bilateral pelvic and aortic lymph node sampling (except in borderline tumors, well differentiated, mucinous, and granulosa cell (GC) neoplasms), endometrial biopsy, appendectomy in mucinous type. Overall, seven patients (26%) were upstaged. Six patients received adjuvant platinum-based chemotherapy. Two term pregnancies occurred. After a median follow-up of 20 months all patients are alive; one patient has FIGO stage Ic clear cell carcinoma, which recurred 8 months after surgery.


CONCLUSIONS
Laparoscopic fertility-sparing staging in early ovarian malignancies is feasible and safe in selected and counseled patients and should be performed in experienced gynecological oncology centers trained in endoscopic procedures.
Department of Obstetrics and Gynecology, Campus Biomedico University, Rome, Italy.
Ludovico
L
Muzii
Innocenza
I
Palaia
Milena
M
Sansone
Marco
M
Calcagno
Francesco
F
Plotti
Roberto
R
Angioli
Pierluigi Benedetti
PB
Panici
D003376:Counseling; D015653:Cystectomy; D005260:Female; D005298:Fertility / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010048:Ovarian Cysts / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D010052:Ovariectomy; D011446:Prospective Studies