THE YIELD OF SURGICAL STAGING IN PRESUMED EARLY-STAGE OVARIAN-CANCER - BENEFITS OR DOUBTS

Background and aim of the study: Since the introduction of the staging procedure for presumed early stage ovarian cancer, only relatively fe w studies have evaluated the yield and the morbidity of comprehensive surgical staging. We have reviewed our own experience with this proced ure to assess whether surgical staging gives significant information t o warrant the possible morbidity of the procedure and whether subseque nt changes in stage alter therapy. Methods: The clinicopathologic reco rds of all patients with presumed early stage ovarian cancer, includin g borderline tumors, between 1981 and 1996 were reviewed. A comprehens ive surgical staging procedure was accomplished in all patients, eithe r primarily or secondarily. No patient received adjuvant therapy befor e the staging procedure. The yield of the procedure in terms of upstag ing and the correlation of upstaging with clinicopathologic features w ere assessed, as well as the morbidity of the staging laparotomy. Resu lts: In 29% (13/45) of patients the staging laparotomy resulted in ups taging, with 54% of these finally diagnosed as stage III disease. The upstaging in all patients was caused by microscopic disease, without g ross abnormalities being present. Upstaging was significantly correlat ed with histologic tumor type, serous lesions being more likely to be upstaged (P < 0.005). No relationship was seen with age or histologic grade. Intra-or postoperative complications occurred in 29% of the pat ients, and 69% of these were minor. The complication rate in secondary staging procedures was significantly higher than in primary procedure s (77% vs. 23%) (P < 0.05). If adjuvant treatment had been based on th e original diagnosis, 63% of upstaged patients with frankly invasive o varian cancer would have been denied treatment. Conclusions: In appare nt early stage ovarian cancer the yield of upstaging justifies a compr ehensive surgical staging. This procedure is best performed at the tim e of the initial surgery since intra-and postoperative complications a re rare. Surgical staging might not be a prognostic factor in itself, and additional features of biologic behavior of the tumor should be in cluded in future clinical research to tailor possible adjuvant treatme nt.