Short-Term Morbidity and Long-TermRecurrence Rate of Ovarian Dermoid CystsTreated by Laparoscopy Versus Laparotomy

Abstract

ObjectiveTo compare the short-term morbidity and the long-termrecurrence rate of ovarian dermoid cysts in women treatedconservatively by laparoscopy with the outcomes in women treatedby laparotomy. MethodsThis retrospective multicentre cohort study compared theoutcomes of removal of dermoid cysts by laparoscopy with removalby laparotomy. All specimens were confirmed histologically asdermoid cysts. We reviewed all medical records and identified allsurgical interventions for dermoid cysts over a 10-year period(1993–2003) in two academic centres in Quebec City.Of the 299 women treated for ovarian dermoid cysts, 167 weretreated by laparotomy and 132 were treated by laparoscopy. Tocompare short-term morbidity, we excluded those who hadundergone oophorectomy or any concomitant surgery, and weconsequently reviewed the records of 98 patients in the laparotomygroup and 100 patients in the laparoscopy group. To comparelong-term recurrence rates we excluded only those patients whohad had oophorectomy. In total, 245 women with availablefollow-up were identified as having ovarian cystectomy (95 in thelaparoscopy group and 150 in the laparotomy group). Two-tailedFisher exact test was used for analysis of categorical variables,and Student t test or Wilcoxon rank test were used for analysis ofcontinuous variables comparing the two groups. Life table analysisusing the Kaplan-Meier method was performed to assess the riskof long-term recurrence. ResultsThe mean diameter of the cyst in women who had alaparotomy was significantly larger than in women who hadlaparoscopy (8.27 cm vs. 5.94 cm), and significantly more womenin the laparotomy group had bilateral cysts (16% vs. 5% in thelaparoscopy group). In women who had laparoscopy, operatingtime was greater (P = 0.0363), but blood loss was less(P < 0.0001) and duration of hospital stay (P < 0.0001) wasshorter. Spillage of the cyst’s contents occurred in 18% of cases inthe laparoscopy group and in 1% in the laparotomy group.Conversions of laparoscopy to laparotomy occurred in 11% ofcases, mainly because of cyst size. Postoperative complicationrates were similar in the two groups. Reintervention rate was 4.2%in the laparoscopy group and 0% in the laparotomy group(P = 0.0217). Using life table analysis, the probability of recurrence at two years was 7.6% (95% confidence intervals 2.9, 19.2) in thelaparoscopy group and 0% in the laparotomy group. ConclusionOvarian cystectomy performed by laparoscopy isassociated with a higher incidence of intra-abdominal spillage thanlaparotomy, but this is not associated with any increase inmorbidity. Laparoscopic treatment results in a shorter hospital stayand less intraoperative blood loss than laparotomy, but it isassociated with a significantly higher risk of recurrence.