title: The significance of comprehensive staging surgery in malignant ovarian germ cell tumors.
abstract: OBJECTIVE
  To evaluate the clinical significance of fertility-preserving comprehensive staging surgery (CSS) in the treatment of malignant ovarian germ cell tumors (MOGCTs).
  
  
  METHODS
  A total of 92 cases of MOGCTs were retrospectively reviewed.
  
  
  RESULTS
  Forty-six patients (50%) received CSS, which includes ipsilateral adnexectomy+omentectomy+retroperitoneal lymphadenectomy (appendectomy and multiple biopsies as required). Forty-six patients (50%) received USO, which includes ipsilateral adnexectomy+clinical intraoperative evaluation (including retroperitoneal lymph nodes, great omentum, peritoneal, and contralateral ovary), biopsy of suspicious sites, and excision of all visible lesions. The mean operation time (177.0 vs. 114.8 min; p<0.0001) and the mean intraoperative blood loss (499.1 ml vs. 112.9 ml; p=0.04) were significantly higher in the CSS group compared to those in the USO group. The complication rate (17.4% vs 0%, p=0.003), the relapse rate (10.9% vs 2.2%, p=0.102) and the mortality rate (4.3% vs 2.2%, p=0.500) were higher in the CSS group compared to those in the USO group. The difference in complication rate was statistically significant. The overall 5 year survival rates were 92% and 97% in the CSS and USO groups, respectively (p=0.575). Tumor-free survival rates at 5 years were 87% and 97% in the CSS and USO groups, respectively (p=0.115).
  
  
  CONCLUSIONS
  The benefit of fertility-preserving CSS to MOGCT patients was not greater than that of USO. It is safer and more effective to perform ipsilateral adnexectomy+clinical intraoperative exploration surgery (including retroperitoneal lymph nodes, great omentum, peritoneal, and contralateral ovary), biopsy of suspicious sites, excision of all visible lesions, and adjuvant chemotherapy.
authors.affiliation: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Liu
authors.forename: Xilai
authors.initials: X
authors.lastname: Ding
authors.forename: Jiaxin
authors.initials: J
authors.lastname: Yang
authors.forename: Dongyan
authors.initials: D
authors.lastname: Cao
authors.forename: Keng
authors.initials: K
authors.lastname: Shen
authors.forename: Jinghe
authors.initials: J
authors.lastname: Lang
authors.forename: Guonan
authors.initials: G
authors.lastname: Zhang
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Xin
authors.forename: Xing
authors.initials: X
authors.lastname: Xie
authors.forename: Yumei
authors.initials: Y
authors.lastname: Wu
mesh_terms: D000328:Adult; D005260:Female; D059247:Fertility Preservation; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008197:Lymph Node Excision; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology* / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D010052:Ovariectomy; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complete staging surgery; Germ cell tumors