DIAGNOSIS AND THERAPY OF ADNEXAL MASSES IN POSTMENOPAUSAL WOMEN: A PROSPECTIVE STUDY

Abstract

Objectives This prospective study was conducted to examine the safety and efficacy of the operative laparoscopic management of adnexal masses in the postmenopause and to define the limits of this procedure. Main outcome measure The parameter chosen for testing the preoperative diagnostic model was the laparoscopic operation of a malignant ovarian tumour. Design This hospital‐based study included 265 consecutive postmenopausal patients with adnexal masses. After preoperative pelvic examination, transvaginal/abdominal ultrasound and determination of the tumour marker CA 125, primary laparoscopy was performed in 69.4% (group A) and primary laparotomy in 30.6% (group B). In 4.2% the patients were converted to laparotomy following diagnostic endoscopy (group Ab); in 65.2% the operative laparoscopic adnectomy was completed (group Aa). Results In the total sample, 81.1% of the tumours were classified as definitely benign, 3.8% showed borderline changes and 15.1% were malignant. The malignancy rate in group A was 3.8% with 2.2% in group Ab, and in group B it was 53.1%. Complications occured in 1.9% of cases, without statistically significant differences between the two groups. Conclusion By combining pelvic examination, transvaginal/abdominal ultrasound, determination of the tumour marker CA 125, and adequate intraoperative evaluation during laparoscopy, the risk of laparoscopic operation of a malignant adnexal tumour can be reduced to a minimum. After carefully weighing up the benefits and risks, we consider a laparoscopic approach to be justified in a selected patient population in the postmenopause, provided the team has sufficient experience in the preoperative assessment of adnexal masses.