Review Article
Laparoscopy and Ovarian Cancer: A Paradigm Change in the Management of Ovarian Cancer?

https://doi.org/10.1016/j.jmig.2009.01.007Get rights and content

Abstract

A MEDLINE search was conducted using the keywords “laparoscopy ovarian cancer,” “laparoscopy and borderline ovarian tumors,” “advanced stage ovarian cancer,” “laparoscopic cytoreduction ovarian cancer,” “laparoscopy intraperitoneal catheter,” “port-site metastases,” and “carbon dioxide pneumoperitoneum.” The publications were further limited to English-language articles, those addressing adnexal mass management, early stage ovarian cancer, and advanced stage ovarian cancer treatments.

The articles were divided into 4 broad categories: adnexal masses, low malignant potential tumors, early stage ovarian cancer, and advanced ovarian cancer. For each category, a further subdivision into case reports, case series, and finally cohorts was developed and summarized. Additional articles were obtained based on the bibliographic cross-reference of the initial articles reviewed.

The current literature defining the role of laparoscopy in the diagnosis and treatment of ovarian cancer is limited to case reports, case series, and cohort studies. However, these limited studies suggest equal efficacy of laparoscopy compared with laparotomy in both early and advanced stage ovarian cancer.

Section snippets

Adnexal Mass

The most frequent detection of an adnexal mass is during an incidental finding on imaging, examination in an asymptomatic patient, or during a diagnostic evaluation for a symptomatic patient 3, 19. The preoperative evaluation includes a history, physical examination, and imaging. Risk factors for ovarian cancer include increasing age, nulliparity, infertility, endometriosis, and a family history of cancer. Postmenopausal patients with adnexal masses undergoing surgical evaluation may have up to

Low Malignant Potential or Borderline Ovarian Tumors

Borderline ovarian tumors represent 10% to 20% of epithelial ovarian cancers and typically have an excellent prognosis [47]. Survival for all borderline ovarian tumors ranges from 92% among those with advanced stage disease to 98% in those with stage I disease [48]. Borderline ovarian tumors occur predominantly in a premenopausal population with the highest frequency occurring in patients aged 30 to 50 years with 50% to 85% diagnosed as stage I [49]. The 2 most frequent histologic subtypes of

Early Stage Invasive Ovarian Cancer

Early stage invasive ovarian cancer requires complete surgical staging to obtain important prognostic information, avoid understaging of patients, and dictate postoperative management. This traditionally involves total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies, pelvic and paraaortic lymph node dissection, and peritoneal washings [65]. If complete staging was not performed at the initial time of diagnosis, a restaging procedure that may be

Advanced Stage Invasive Ovarian Cancer

Most patients with ovarian cancer are given the diagnosis of either FIGO stage III or IV disease. The mainstay of treatment includes optimal surgical cytoreduction followed by platinum-based combination chemotherapy [5]. Clinical risk factors that contribute to poor prognosis include FIGO stage IV disease, greater than 5 cm residual tumor, greater than 20 residual lesions, greater than 1 L of ascites, poor performance status, older age, poor histology, high tumor grade, and high postoperative

Pitfalls of Laparoscopy Management in Ovarian Cancer

Several main concerns have limited the widespread use of laparoscopy in ovarian cancer: the potential for inadequate staging, tumor cell peritoneal dissemination with carbon-dioxide (CO2) pneumoperitoneum, possibly a higher incidence of cyst rupture, and port-site metastases. These pitfalls of laparoscopy are discussed below.

Conclusion

Laparoscopy was initially applied in gynecology as a diagnostic tool in ovarian cancer management. With the continued expansion of endoscopic techniques and instruments, laparoscopy is quickly emerging as a feasible alternative to laparotomy in managing ovarian cancer. This approach repeatedly revealed advantages over laparotomy including shorter hospitalizations, lower blood loss, improved visualization, a reduction in need for postoperative analgesics, less morbidity, and more rapid recovery.

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    The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

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