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abstract
Highlights
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- Stage of disease is still the most important prognostic factor in early ovarian cancer.
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- Among early ovarian cancer patients there is a non-negligible percentage of upstaged patients.
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- A complete and accurate surgical staging can be safely achieved through laparoscopic surgery, when performed in referral centers.
Abstract
Objective
The
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 methods
Retrospective
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.
Results
Longer
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).
Conclusion
In
this very large multi-institutional study, it appears that patients with
apparent ESOM can safely undergo laparoscopic surgical management.
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