The unexpected ovarian malignancy found during operative laparoscopy: Incidence, management, and implications for prognosis

Abstract

3 fi l r p The laparoscopic approach to adnexal masses has not yet eached universal acceptance. The possibility of encounterng an unexpected ovarian malignancy during operative aparoscopy has been for many years a major factor against he laparoscopic approach to ovarian cysts. Intraoperative yst rupture, which commonly occurs during laparoscopy, pstages the unexpected ovarian cancer from stage IA to tage IC, with all the consequences of possible delayed taging, necessity of adjuvant chemotherapy, and worse rognosis. Accurate preoperative selection remains the ainstay in the management of ovarian cysts. An unuspected ovarian malignancy can be expected to be enountered in approximately 0.9% of strictly selected, beign-appearing cysts in premenopausal patients. In ostmenopausal patients, this rate rises to 3.0%. In the case f cysts that appear suspect during preoperative ultrasound, he rate of unexpected malignancy rises further to 13.3%. ppropriate intraoperative management is mandatory in orer not to worsen the patient’s prognosis. The laparoscopic approach to ovarian cysts has been a ontroversial topic for years. If, on the one hand, there is no oubt that laparoscopy represents the gold standard for the reatment of benign diseases such as ectopic pregnancy, adheions, or minimal endometriosis, on the other hand, the time for cceptance of laparoscopy for the treatment of ovarian cysts as not yet come. The possibility of approaching by laparoscopy an ovarian yst that is instead an unexpected ovarian cancer represents the