Laparoscopic Treatment and Staging of Early Ovarian Cancer

Study ObjectiveTo review the laparoscopic staging procedure in a series of patients with early ovarian cancer and compare results with the literature.DesignA prospective single-center study (Canadian Task Force classification II-2).SettingA hospital in Spain.PatientsA total of 20 patients with apparent early stage ovarian cancer from January 2003 through November 2007. The histologic tumor types were epithelial tumors (18 patients) and dysgerminoma (2 patients). Among the epithelial tumors, 11 were invasive and 7 were borderline (3 serous and 4 mucinous).InterventionsComprehensive laparoscopic staging was performed in all patients according to the International Federation of Gynecology and Obstetrics guidelines.Measurements and Main ResultsSeventeen patients had previous adnexal surgery and diagnosis and surgical staging were performed in only 3 patients during the same surgery. The patients’ median age was 42.8 years (range 16–67). Eight (40%) patients desired to maintain fertility and a conservative approach was performed for this group. Laparoscopic staging was completed in 19 (95%) patients. In 1 case, a conversion to laparotomy was necessary as the para-aortic lymphadenectomy was completed because of a vessel lesion that was repaired without difficulty. The median operative time was 223 minutes (range 180–320) for radical surgery and 188 minutes (range 120–240) for the conservative approach. The mean hospital stay was 3 days. Of the 20 total patients, 4 (20%) were upstaged. The median follow-up was 24.7 months (range 1–61), with a disease-free survival of 95% and an overall survival of 100%. One recurrence was observed.ConclusionA comprehensive surgical staging procedure is clearly indicated in cases of early ovarian cancer and oncologic guidelines should be respected. The laparoscopic approach could be a valid alternative to laparotomy.