Management of adnexal masses: Role and risk of laparoscopy

Laparoscopic surgery has become the gold standard in the treatment of benig n adnexal masses, whereas laparotomy remains the standard for the treatment of malignant tumors. The laparoscopic management of adnexal masses remains controversial because of the potential risks of cancer dissemination sugge sted by many case reports and national surveys. Experimental data show pote ntial advantages and disadvantages for the laparoscopic treatment of gyneco logic cancer. Since the risk of dissemination appears high when a large num ber of malignant cells are present, adnexal tumors with external growths an d bulky lymph nodes may be considered contra-indications to CO2 laparoscopy . Surgical diagnosis is the key to adequate management of adnexal masses. I n our experience, laparoscopic diagnosis of malignancy is reliable after a careful pre-operative evaluation has been performed. Moreover, national sur veys have revealed that despite suspicious laparoscopic findings, many mali gnant masses were considered benign at the outset. Using strict guidelines, laparoscopic diagnosis can be proposed for both non-suspicious and complex masses, thus avoiding many unnecessary laparotomies for benign masses susp icious at ultrasound. The more controversial limits of laparoscopic treatme nt are discussed. If a laparotomy was performed for all masses suspicious a t surgery, 80% of the cases would be treated by laparoscopy. The role of la paroscopy for restaging and second-look operations for ovarian cancer requi res further evaluation. Semin. Surg. Oncol. 19:28-35, 2000. (C) 2000 Wiley- Liss, Inc.