LAPAROTOMY TO COMPLETE STAGING OF PRESUMED EARLY OVARIAN-CANCER

Objective: To assess the findings and complications of laparotomies fo r completely staging presumed early-stage ovarian cancer in patients w hose initial surgery was inadequate. Methods: Records of 45 patients s urgically restaged at our institution, after having been incompletely staged elsewhere, were reviewed for original operative reports, pathol ogic diagnoses, restaging procedures, operative results, and periopera tive complications. Results: Initial clinical staging was IA, 28; IB, three; IC, 12; IIA, one; IIB, one. Histologic distribution was as foll ows: invasive epithelial, 19 (42%); borderline epithelial, 16 (36%); g erm cell tumor, seven (16%); and stromal tumor, three (6%). Seven of t he 45 patients (16%) had their disease reclassified to a more advanced stage. Of patients with borderline ovarian tumors, two, initially sta ged as IA, were restaged to IB and IC, and one was restaged from IIB t o IIIA. Three patients with invasive epithelial adenocarcinoma were re classified to a higher stage: one, with a presumed stage IC, poorly di fferentiated adenocarcinoma, to IIIB; one, with a stage IC, grade 2 mu cinous cystadenocarcinoma, to IIIA; and a third, with a IIA, poorly di fferentiated adenocarcinoma, to IIIC. A patient with granulosa cell tu mor, initially staged as IC, was restaged to IIB. Fifteen patients (33 %) had complications after restaging surgery. Seven (16%) patients und ergoing restaging laparotomy for presumed early ovarian cancer were re classified to a higher stage, resulting in alteration of treatment for only one patient. In 18 patients with invasive cancer, the second ope ration confirmed the presence of low-risk stage IA/B disease, allowing adjuvant chemotherapy to be withheld. Conclusion: Although restaging laparotomies provide important prognostic information with minimal mor bidity, they provide little benefit to those patients already requirin g chemotherapy based on the original operative findings.