Laparoscopic staging of apparent early stage ovarian cancer: Results of a large, retrospective, multi-institutional series

- Stage of disease is still the most important prognostic factor in early ovarian cancer.
- Among early ovarian cancer patients there is a non-negligible percentage of upstaged patients.
- A complete and accurate surgical staging can be safely achieved through laparoscopic surgery, when performed in referral centers.

ObjectiveThe aim of this study is to analyze the safety, adequacy, perioperative and survival figures in a large series of laparoscopic staging of patients with apparent early stage ovarian malignancies (ESOM).Patients and methodsRetrospective data from seven gynecologic oncology service databases were searched for ESOM patients undergoing immediate laparoscopic staging or delayed laparoscopic staging after an incidental diagnosis of ESOM.Between May 2000 and February 2014, 300 patients were selected: 150 had been submitted to immediate laparoscopic staging (Group 1), while 150 had undergone delayed laparoscopic staging (Group 2) of ESOM. All surgical, pathologic, and oncologic outcome data were analyzed in each group and a comparison between the two was carried out.ResultsLonger operative time, higher blood loss, more frequently spillage/rupture of ovarian capsule and conversion to laparotomy occurred in Group 1. No significant differences of post-operative complications were observed between the two groups. Histological data revealed more frequently serous tumors (0.06), Grade 3 (p = 0.0007) and final up-staging (p = 0.001) in Group 1. Recurrence and death of disease were documented in 25 (8.3%), and 10 patients (3.3%%), respectively. The 3-year disease free survival (DFS) and overall survival (OS) rates were 85.1%, and 93.6%, respectively in the whole series. There was no difference between Group 1 and Group 2 in terms of DFS (p value = 0.39) and OS (p value = 0.27).ConclusionIn this very large multi-institutional study, it appears that patients with apparent ESOM can safely undergo laparoscopic surgical management.