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Korean Journal of Obstetrics & Gynecology 1998;41(3):777-787.
Published online January 1, 2001.
A Clinical Study about Ovarian Neoplasms Treated by Laparoscopic Surgery Subsequently Found to Be Malignant.
J H Na, J H Kim, S H Lee, H E Oh, Y M Kim, Y T Kim, B M Kang, C H Nam, J E Mok
Abstract
The use of operative laparoscopy for the management of adnexal mass has increased dramatically with rapid evolution in technology and improved surgical skills in the last few years. Of particular concern is the laparoscopic excision of ovarian neoplasms proven to be malignant during or after laparoscopic surgery. The proper selection of patients is utmost important before laparoscopic surgery, and it has been possible in some aspects with an aid of high-resolution ultrasonography, color Doppler assessment and various serum tumor markers such as CA 125. Indeed, the incidence of encountering unexpected malignancies has been reported to be very low. The potential problems in these cases include inadequate patient preparation, inappropriate surgical procedures, incomplete surgical staging, delay in definite therapy and worsening prognosis by spillage of tumor cells. We analysed our experience of 7 cases of ovarian cancer diagnosed during or after laparoscopic surgery, and obtained the following RESULTS: 1. The range of the patients` age was from 25 to 47 years with the average parity of 1.1+/-0.2 [mean+/-S. D.]. 2. The mean maximal diameter of the tumors measured by ultrasonography was 11.7 cm [range: 5~40 cm] and the most of the tumors were semisolid nature containing partly solid area or septa. 3. The preoperative serum CA 125 was checked in 5 cases, and the range was from 4.2 to 721 U/ml. 4. Washing cytologic examination was performed in only 2 cases and showed no malignant cell in both. Frozen section was performed in 6 cases, and 2 cases of malignancy were falsely diagnosed as benign tumors. 5. Management at the time of the initial laparoscopic procedure were unilateral salpingoophorectomy[6 cases] and ovarian cystectomy[1 case]. Laparotomy was performed immediately in 2 cases and after 7 days in 1 case. 6. 57 % [4 cases] of the patients had stage Ia disease and the others had stage Ic, IIc and IIIa diseases. 7. Postoperative chemotherapy was performed in 5 cases including 3 cases of stage Ia diseases. In conclusion, the strict selection criteria using sonographic findings and serum tumor markers and the liberal frozen section should be applied in the laparoscopic management of ovarian tumor. Well-designed prospective study should be performed to evaluate the safety and efficacy of laparoscopic management of ovarian cancer.
Key Words: Laparoscopic surgery, Ovarian cancer


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