Risk of spread of ovarian cancer after laparoscopic surgery

The incidence of the spread of ovarian cancer after laparoscopic surgery is difficult to establish from the current literature. The prognosis incidenc e of a trocar site metastasis without peritoneal dissemination is not known . Data from general surgeons in prospective studies from a single instituti on suggested that in colon cancer the risk is low, whereas it seems to be m uch higher in multicentric studies of undiagnosed gallbladder cancer. Exper imental studies suggested that laparoscopy has advantages and disadvantages . However, the risk of dissemination is high when a large number of maligna nt cells and a carbon dioxide pneumoperitoneum are present, a situation enc ountered when managing adnexal tumours with large vegetations. Animal studi es will allow the development of a peritoneal environment adapted to the tr eatment of cancer. The ovary is an intraperitoneal organ and ovarian cancer a peritoneal disease, so the risk of peritoneal spread may be higher in ov arian cancer than in other gynecological cancers. A careful preoperative ev aluation appears to be the best way to prevent these risks. It should also be used to choose which patient should be operated by which surgical team. The second step is a careful and cautious laparoscopic diagnosis, so that m ore than 98% of ovarian cancers encountered can be treated immediately and effectively. The laparoscopic management of ovarian cancer remains controve rsial; it should be performed only in prospective clinical trials. Until th e results of such studies become available, an immediate vertical midline l aparotomy remains the gold standard if a cancer is encountered. Curr Opin O bstet Gynecol 13:9-14. (C) 2001 Lippincott Williams & Wilkins.