Laparoscopic Treatment Of Malignant Ovarian Tumors - Late Results

Objective: Although laparoscopic surgery for adnexal masses has become a standard procedure there is still concern whether the prognosis of the disease is worsened when unexpected malignancy is encountered.Methods: From Jan. 1994 to Dec. 2000 41 patients with malignant ovarian tumors were laparoscopically treated in the "Tagesklinik Altonaer Strasse (dayclinic). Operation- and histology reports and all other treatment documents of the patients were analyzed in cooperation with the department of oncology of the "Frauenklinik Barmbek-Finkenau".Results: 3687 patients had laparoscopy for an ovarian tumor. in 41 cases (1.1%) malignancy was confirmed. A frozen section was performed in 35 cases (85.4%). Borderline malignancy was found in 25 cases (61%), ovarian cancer in 11 cases (26.8%), a granulosacelltumor in 2 cases (4.9%) and one case each of a dysgerminoma, an endodermal sinuscelltumor and a cholangiocellular carcinoma. Oophorectomy was performed in 22 cases (53.5%), cystectomy in 13 (31.7%), biopsy in 4 (9.8%) and a lavage in 2 cases (4.9%). In all cases the tumor was saved in a bag or via laparotomy. 28 patients were referred to an oncology department immediately after the diagnosis was confirmed. 20 patients (71.4%) were referred to the oncology unit of the "Frauenklinik Barmbek-Finkenau". After an average of 8.3 days 20 patients were radically operated. 7 patients were staged via laparotomy, in 5 patients a second-look laparoscopy was performed after 6 months. 9 patients received no further treatment. The mean observation time was 45.8 months (8-91). 3 patients died of the disease. One of them had an endodermal sinuscelltumor and two had metastatic cancer from the beginning. 2 patients had a recurrence, but are still living (one with a granulosacelltumor, one with ovarian cancer). In one patient with borderline malignancy pT1a and after performing oophorectomy and a staging operation an ovarian cancer developed in the contralateral side after three years.Conclusion: Laparoscopic surgery for ovarian tumors subsequently found to be malignant does not alter the prognosis of the disease if oncologic cautela are taken into consideration and close cooperation with an oncologic unit takes place.