Abstract
BACKGROUND:
Surgery
is the mainstay of treatment for early ovarian cancer both as
therapeutic and comprehensive staging. Only the latter allows
appropriate tailoring of systemic treatment.
However, the compliance
with guidelines for comprehensive staging has been reported to be only
moderate and, therefore, re-staging procedures are commonly indicated to
avoid undertreatment. The purpose of our study was to evaluate
re-operation in a tertiary gynecologic oncology unit after primary
operation for presumably ovarian cancer
FIGO I-IIIA in general
gynecology departments.
MATERIAL AND METHODS:
Forty
consecutive patients after primary surgery in
the outside institutions
for presumed early ovarian cancer with assumed tumor spread limited to
the pelvis (FIGO I-IIIA) admitted to our department between 1999 and
2007 were included.
In 35 cases re-staging surgery in our unit was
indicated. The intra- and post-operative results were compared with
initial diagnosis and sites of undetected disease were evaluated.
Reasons for re-staging and referral pattern were studied.
RESULTS:
40
patients were enrolled of whom 53% came by self-referral.
Only 18% were
referred by the primary surgeon and the remaining patients were
referred by their home gynecologist. Only 5 patients (13%) were
classified as having had a comprehensive staging by surgical records and
pathology reports and 35 patients underwent comprehensive re-staging
laparotomy after which 20 patients
(50%) experienced an upstaging
including 13 patients with final diagnosis of FIGO stage IIIC. Most
frequent sites of primarily undetected tumor were peritoneum (pelvic
34%, diaphragm 13%, paracolic 8%), lymph nodes (para aortic 32%, pelvic
11%), intestines 24%, and residual omental tissue 18%. The indication
for post-operative chemotherapy was modified in 53% of patients.
CONCLUSION:
Comprehensive
staging of presumed early ovarian cancer has been described as major
problem especially outside gynecologic oncology units. Re-staging
results in our department confirmed this deficiency by showing a
considerable proportion of upstaging associated with alterations of
recommendations for systemic treatment.
However, series like this may
even underestimate the problem, because incomplete staging is
unfortunately accompanied by non-systematic referral practices not
reflecting staging quality.
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