Feasibility Study of the Laparoscopic Approach for Borderline Ovarian Tumors

Abstract

Objectives: Compared to ovarian cancers, borderline ovarian tumors (BOTs) primarily present at an early stage in younger patients and have an excellent overall prognosis. Clinical management of BOTs during reproductive age has been modified from radical surgery to fertility-sparing surgery. However, the accurate diagnosis of BOTs prior to surgery is currently difficult. The aim of this study was to evaluate the feasibility of the laparoscopic approach for BOTs in terms of clinical outcome, including pre and intra-operative diagnosis.
Methods: From January 2005 through December 2012, we retrospectively reviewed the clinical and surgical parameters of patients undergoing surgery for epithelial BOTs at our institution.
Results: A total of 119 BOTs were analyzed. For initial surgery, 111 (93%) underwent a laparotomy, and 8 (7%) underwent laparoscopic surgery. All the cases that underwent laparoscopic surgery were selected under a preoperative diagnosis of adenoma. Among 119 BOTs, 70 (64%) had solid areas and 50 (82%) had contrast enhancements in the tumor that was revealed by magnetic resonance imaging. The accuracy of intraoperative frozen section diagnosis was 84%. The incidence of tumor rupture during surgery was significantly higher in the laparoscopic surgery group compared to laparotomy group (P = 0.0007); however, there was no significant difference in the recurrence rate between stage Ia and Ic (b) patients.
Conclusions: Pre- and intra-operative characterization of ovarian tumors using enhanced imaging studies and frozen section is clinically important. Although further studies are needed, with appropriate patient selection, laparoscopic surgery might be an acceptable intervention for young women with BOTs.