The clinical value of surgeons' efforts of preventing intraoperative tumor rupture in stage I clear cell carcinoma of the ovary: A Korean multicenter study

• Neither intraoperative rupture nor peritumoral adhesion was associated with poor prognosis in stage I ovarian CCC.
• Stage IC2/IC3 was the only independent poor prognostic factor for overall survival in patients with stage I ovarian CCC.
• Unintentional spillage of endometriosis-associated ovarian tumor confined to ovary is not to be blamed.

ObjectiveTo demonstrate the survival impact of intraoperative tumor rupture in women with stage I clear cell carcinoma (CCC) of the ovary.MethodsA total of 193 patients with stage I CCC of the ovary who had undergone a complete staging operation followed by ≥ three cycles of adjuvant platinum-based chemotherapy, were retrospectively reviewed. Survival analysis was performed and compared between three stage groups: IA/IB, IC1, and IC2/IC3.ResultsThere were 70, 51, and 72 women with ovarian CCC in stages IA/IB, IC1, and IC2/IC3, respectively. Intraoperative tumor rupture occurred in 69 (35.8%) patients. Gross endometriosis (p = 0.020) and significant peritumoral adhesion (p < 0.001) were associated with intraoperative tumor rupture. However, neither laparoscopic approach nor large tumor size > 10 cm were associated with intraoperative tumor rupture. Patients with stage IC2/IC3 compared to those with stage IC1, had poorer progression-free survival (PFS) (5-year PFS, 68.5% versus 91.7%; p = 0.010) and overall survival (OS) (5-year OS, 81.1% versus 95.4%; p = 0.027). However, there was no significant difference between patients with stages IA/IB and IC1 CCC in PFS (5-year PFS 88.8% versus 91.7%; p = 0.291) and OS (5-year OS 94.6% versus 95.4%; p = 0.444). Stage IC2/IC3 was the only independent poor prognostic factor for OS (hazard ratio, 3.50; 95% confidence interval, 1.31 to 9.36).ConclusionSurgical spillage of tumor cells does not appear to have a negative impact on survival outcomes of women with stage I ovarian CCC who received ≥ three cycles of adjuvant platinum-based chemotherapy.