Laparoscopic Restaging of Early-Stage Adnexal Tumors: A 10-Year Experience

Abstract

In the 10 years, between December 1991 and December 2001, 53 patients with early adnexal tumors, including 35 ovarian carcinomas and 7 fallopian tube carcinomas, underwent laparoscopic surgery for restaging after incomplete initial surgery. Laparoscopy was performed in 42 patients (primary restaging group) at an average of 8.3 weeks after initial surgery. Eleven patients, who received chemotherapy because of unfavorable histologic diagnoses after initial surgery, underwent restaging laparoscopy after the completion of treatment (secondary restaging group). Laparoscopic staging protocol involved thorough inspection of all peritoneal surfaces after a washing for cytology. Any suspicious areas were biopsied or 8 to 10 random biopsies were obtained. A thorough pelvic and paraaortic lymphadenectomy and an infracolic was done. Most cases included an appendectomy, and a laparoscopically assisted vaginal hysterectomy and/or salpingo-oophorectomy was performed when warranted. Nine women with ovarian cancer received fertility-sparing surgery. The average age was 41.3 years (range, 18–63 years) for patients with ovarian carcinoma and 57.9 years for those with fallopian tube tumors. Body mass indexes were a mean of 23.8 and 23.9 kg/m2, respectively. Laparoscopic procedures (including those with hysterectomy or salpingo-oophorectomy) averaged 238 minutes (range, 120–370 minutes) in operating room time. The numbers of nodes resected ranged from 7 to 20 in the para-aortic area (mean, 20) and 4 to 27 (mean, 14) in the pelvic area. The average number of days in the hospital was 3.1 (range, 1–5). Operative complications in the primary staging group included 1 epigastric vessel hematoma and 2 lymphocytes, all of which were corrected laparoscopically. In the secondary staging group, there was a transection of a lumbar ureter that required laparotomy. In the primary restaging group, 8 patients, including 4 with ovarian carcinoma and 4 with fallopian tube carcinoma, were upstaged as a result of primary restaging (8 of 42, 19%). Two were reclassified as stage II, 2 as III, and 4 as IIIC. These patients received 6 courses of platinum-based chemotherapy. The remaining 34 women were stage IA, grade 1 or 2, and were managed expectantly. Average follow up was 54 months (range, 8–116). In the primary restaging group, 1 of the 8 women who were upstaged recurred at 8 months and died after 24 months. There were 3 recurrences among the remaining 34 patients. Two with ovarian carcinoma recurred at 29 and 35 months; 1 patient with fallopian tube carcinoma recurred at 55 months. There have been 3 successful pregnancies among the 9 patients in the primary staging group who received-paring treatment. Four of the 11 patients in the secondary restaging group (36%) were found to have persistent disease after chemotherapy (3 stage IIIC and 1 IIC). One woman with persistent disease after chemotherapy recurred at 10 months and died at 14 months.