Laparoscopic restaging of borderline ovarian tumours (BLOT): a retrospective study of 142 cases

abstract

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Objectives

Primary objective: To analyse the impact of restaging, on recurrences and survival, in BLOT. Secondary objective: To cluster patients who could be exempted from restaging.

Study design

This retrospective study, included patients operated for a BLOT, between January 1990, and December 2007, in gynaecological surgery units of the University Hospital of Clermont-Ferrand.

Two groups were evaluated: patients with and without optimal restaging.

Results

One hundred and forty-two patients were included. Optimal initial staging rate was 38.7% (n = 55). Among the eighty-seven women not initially staged, two groups were compared: restaged (n = 45) and non-restaged patients (n = 42). Mean follow-up was 80.5 months. Overall survival was 93.7%. Relapse rate was 7.7% (n = 11). Disease free survival (DFS) was 88% after a mean follow-up of 80.5 months. One death was noted.

Optimal restaging rate was 31.7% (n = 45, 43 by laparoscopy). Mean follow-up was of 87.1 months among restaged patients, 84.5 months among non-restaged patients (p = 0.93).

Relapse incidence was significantly higher in non restaged, than in restaged patients (p = 0.008). DFS was significantly longer among restaged than non-restaged patients, (p = 0.072). Younger age (p = 0.04), conservative treatment (p < 10⁻⁴) or non-diploidy (p = 0.04) increased the incidence of relapse.

Conclusions

When initial staging is missing, restaging improves the patients outcome in comparison to non-restaged groups. Laparoscopy is a valuable surgical option. This study suggests that a selected group of patients, older than 30 years old, submitted to a radical treatment, presenting a diploid, non micropapillar, mucinous BLOT, without visible implants during careful peritoneal inspection, could be exempted from restaging. They represented 11.6% of our population.