術後卵巣境界悪性腫瘍と判明し、腹腔鏡下手術による妊孕性温存手術と surgical stagingを施行した5例の検討

Abstract

Objectives: Clinical management of borderline ovarian tumors (BOTs) during reproductive age has shifted from radical surgery to fertility-sparing surgery. The aim of this study was to evaluate the feasibility of the laparoscopic approach for fertility-sparing surgery for BOTs. Methods: From August 2012 through March 2014, laparoscopic surgery for ovarian tumors was performed for 557 cases, and a total of 11 cases were diagnosed as BOTs. Six patients were premenopausal, and five selected fertility-sparing surgery. We retrospectively reviewed the clinical and surgical parameters of undergoing laparoscopic surgery for reproductive-age women with BOTs at our institution. Results: Four cases had mucinous BOTs and one had granulosa-cell tumor. The mean age was 30.8 (20–43) years and mean diameter was 10.1cm (6–22 cm). Two cases had multi-cystic tumor, and all tumors showed no enhancement by contrast magnetic resonance imaging. Laparoscopic ovarian cystectomy was performed in all cases. All cases underwent a secondary laparoscopic surgery as a fertility-sparing surgery and surgical staging including salpingo-oophorectomy of the affected side, partial omentectomy, and peritoneal observation. Appendectomy was performed for one case. The incidence of perioperative morbidities included one case of suspected ureter stenosis. After surgical staging, no case was up-staged, but a residual tumor was found in the affected ovary of one case. After a mean follow-up of 10.3 months (3–19), none had a recurrence or died of the disease. One case had delivered after the two-stage surgery.Conclusions: Laparoscopic surgery might be feasible and an acceptable intervention for reproductive-age women with BOTs.