Laparoscopic surgery for complex ovarian masses

Study Objective. To assess the value of laparoscopy in managing complex ova rian masses. Design. Retrospective, observational analysis (Canadian Task Force classifi cation IL-2). Setting. University-based, tertiary level center for endoscopic surgery. Patients. Two hundred eleven consecutive women. Interventions. Laparoscopic surgery including ovary-preserving surgery, sal pingo-oophorectomy, adhesiolysis, and pelvic lymphadenectomy. Measurements and Main Results. Patients were selected on the basis of preop erative ultrasound findings. Intraoperative appearance of the tumors as wel l as results from frozen section examinations were compared with histologic results. Two hundred sixteen pelvic masses were benign. In 10 patients, ea rly ovarian cancer, borderline tumors, tubal cancer, or secondary ovarian, nongynecologic pathology was managed primarily by laparoscopy and confirmed histologically. Three of these 10 women underwent standard radical open su rgery within 1 week. The true nature of masses Mas not recognized at the ti me of laparoscopy in three patients with malignant findings. Patients with malignant tumors were followed for 5 years. Conclusion. Although most complex ovarian masses can be managed by laparosc opy the possibility of overlooking malignancy remains, even with frozen sec tion examination. whether or not laparoscopy compromises clinical outcome c ompared with laparotomy is nor fully understood. Prospective studies to add ress this important clinical question are urgently needed.