Impact of staging surgery in the outcomes of patients with early-stage low malignant potential ovarian tumor (LMPOT)

Abstract

5092 Background: Most of LMPOT occur in young patients and are misdiagnosed at the time of initial surgery. So, a new surgery is often required to ensure to the initial stage of the disease carrying out a peritoneal staging. The aim of this study is to assess the clinical outcome of complete staging surgery in early stage LMPOT. Methods: 101 patients treated between 1965 and 1997 for an apparent LMPOT confined to the ovary(ies) (“stage I” disease) were reviewed according to the completion of a staging surgery at the time of initial treatment. Patients in group 1 (n=48; 47%) underwent a complete staging defined as: peritoneal cytology, peritoneal biopsies and omentectomy (with or without lymphadenectomy). Patients including in group 2 (n=53; 53%) had uncompleted staging surgery defined by omission of, at least, one of theses previous procedures. Results: A conservative management was performed respectively in 12 (25%) and 25 (47%) patients in groups 1 and 2. Eight (17%) patients were upstaged in group 1 (isolated positive cytology in 6 and microscopic noninvasive implants on the omentum in 2 patients). None patient was upstaged on the basis of results of random peritoneal biopsies and/or lymphadenectomy. The median time of follow-up were respectively in groups 1 and 2 60 and 120 months. Four (7%) recurrences were observed in group 2 and none in group 1 (p=.07). All these recurrences were serous borderline recurrence following conservative management. None patients recurred under the form of invasive carcinoma and/or peritoneal disease. None patient died from the tumor. Conclusion: In our study, the absence of complete peritoneal staging in patients with apparent early stage LMPOT increases the rate of recurrences. But all of them were borderline tumor after a conservative management and could be safely treated by an iterative surgical procedure without any influence on the survival. Such results could suggest that, in a patients treated for an early stage LMPOT misdiagnosed during the initial surgery, a staging surgery could be omitted if patient agree to be carefully followed-up. No significant financial relationships to disclose.