Surgical staging of early invasive epithelial ovarian rumors

Early stage epithelial ovarian carcinoma is defined pathologically as a tum or strictly limited to one or both ovaries without any extra-ovarian diseas e (i.e., Stage IA or B of the International Federation of Gynecology and Ob stetrics (FIGO) classification). This diagnosis can be obtained only after an exhaustive surgical staging procedure, performed as soon as the diagnosi s of epithelial invasive ovarian carcinoma is established. This staging sur gery currently encompasses a peritoneal cytology, the thorough inspection o f all the visceral and parietal peritoneal surfaces with biopsy of any abno rmality, total abdominal hysterectomy and bilateral salpingo-oophorectomy ( TAH + BSO), random peritoneal biopsies, omentectomy, appendectomy and bilat eral pelvic and para-aortic lymphadenectomies, up to the left renal vein. T he results of this staging procedure and its indications are discussed. In all of the cases, the radical removal of the pathologic adnexa is indicated , along with the complete peritoneal and retroperitoneal staging. While fer tility-sparing surgery (avoiding hysterectomy and contralateral adnexectomy , if possible) seems to be safe for young women, a TAH + BSO is the rule fo r the others. Adjuvant chemotherapy can be omitted in well-differentiated t umors with a negative staging operation, but currently it remains indicated in all other cases. Indeed, the ultimate goal in early stage ovarian carci noma is to not impair by inadequate management the high chance of a cure. S emin. Surg. Oncol. 19:36-41, 2000. (C) 2000 Wiley-Liss, Inc.