Differences in perioperative outcomes after laparoscopic management of benign and malignant adnexal masses

Abstract

ObjectiveTo compare the feasibility and safety of the laparoscopic management of adnexal masses appearing preoperatively benign with those suspicious for malignancy.MethodsRetrospective study of 694 women that underwent laparoscopic management of an adnexal mass.ResultsLaparoscopic management of an adnexal mass was completed in 678 patients. Six hundred and thirty five patients had benign pathology (91.5%) and 53 (7.6%) had primary ovarian cancers. Sixteen patients (2.3%) were converted to laparotomy; there were 13 intraoperative (1.9%) and 16 postoperative complications (2.3%). Patients divided in 2 groups: benign and borderline/malignant tumors. Patients in the benign group had a higher incidence of ovarian cyst rupture (26% vs. 8.7%, p<0.05). Patients in the borderline/malignant group had a statistically significant higher conversion rate to laparotomy (0.9% vs. 16.9%, p<0.001), postoperative complications (1.9% vs. 12.2%, p<0.05), blood loss, operative time, and duration of hospital stay. The incidence of intraoperative complications was similar between the 2 groups.ConclusionLaparoscopic management of masses that are suspicious for malignancy or borderline pathology is associated with an increased risk in specific intra-operative and post-operative morbidities in comparison to benign masses. Surgeons should tailor the operative risks with their patients according to the preoperative likelihood of the mass being carcinoma or borderline malignancy.

Laparoscopic Management of Large Adnexal Masses

“…The results showed that patients with malignancy or metastasis were signi cantly older and had a longer duration of surgery and intra-operative complications. These results are consistent with the results of the study by Gad et al, which reported higher rate of complications and longer operative time in patients with borderline/malignant adnexal mass, compared to benign group undergoing laparoscopic treatment (20).…”

“…Furthermore, they reported higher rate of conversion to open, blood loss, and duration of hospital stay (20), which was not observed in our study. Other studies have also con rmed the superiority of laparoscopy vs. laparotomy for treatment of ovarian cancers (21,22), as well as comparable accuracy of staging of laparoscopy vs. laparotomy and comparable survival rates (23,24), while the results of the present study suggested higher complication rates in large tumors.…”

Laparoscopic versus laparotomic surgery for adnexal masses: role in elderly

“…Mohamad S. Gad and James H. Liu, in their paper, said that LPS was used mainly for benign masses, instead LPT was used mainly for malinant and borderline masses, these results are comparable to our results [ 8 , 9 ].…”

Factors associated with complications and conversion to laparotomy in women undergoing laparoscopically assisted vaginal hysterectomy

“…With the rapid evolution of laparoscopic techniques and instruments, LAVH has become one of the most common procedures for hysterectomy (2). Such laparoscopic surgeries have advantages, such as shorter hospital stays, faster recovery times and better cosmetic outcomes (3,4).…”