INFLUENCE OF DELAYED STAGING LAPAROTOMY AFTER LAPAROSCOPIC REMOVAL OFOVARIAN MASSES LATER FOUND MALIGNANT

Objective: To determine whether delayed laparotomy after attempted lap aroscopic excision of an ovarian mass later found to be malignant has an impact on the stage of disease. Methods: A questionnaire regarding laparoscopic management of ovarian masses later found to be malignant was mailed to all gynecologic departments in Austria. Of the 70 cases reported, laparotomy was performed after laparoscopy in 48 cases. In 2 4 of these cases, laparotomy was performed within 17 days of laparosco py, whereas 24 cases involved a delay of more than 17 days. Twenty-two patients in whom laparotomy was performed immediately after laparosco py were used as controls. Results: In patients with borderline tumors who underwent laparotomy more than 17 days after laparoscopy, the odds ratio (OR) for International Federation of Gynecology and Obstetrics (FIGO) stage IIB-IV disease was 5.3 (95% confidence interval [CI] 0.40 , infinity), compared with patients undergoing immediate laparotomy (m ultivariate analysis). Patients with invasive ovarian cancer who under went laparotomy more than 17 days after laparoscopy had an OR of 9.2 ( CI 0.92, 481) for stage IIB-IV disease compared with patients undergoi ng immediate laparotomy (multivariate analysis). In patients with bord erline tumors, multivariate analysis showed that the timing of laparot omy is an independent prognostic factor for the stage of disease. In i nvasive ovarian cancer, none of the factors evaluated by multivariate analysis was found to be an independent prognostic factor for the dist ribution of disease stage. A delay between laparoscopy and laparotomy may affect adversely the distribution of disease stage. Conclusion: Th e timing of subsequent laparotomy was found to be a factor predictive of the distribution of disease stage. (Obstet Gynecol 1998;92:967-71. (C) 1998 by The American College of Obstetricians and Gynecologists.).