Laparoscopic Ovarian Cystectomy: Selection of Patients and Consequences of Rupture of Ovarian Malignancy

Abstract

AA Rouzi, PF McComb, Laparoscopic Ovarian Cystectomy: Selection of Patients and Consequences of Rupture of Ovarian Malignancy. 1997; 17(3): 321-325 Operative laparoscopy is gaining popularity and widespread application in gynecology. In response to a survey on operative laparoscopy by the American Association of Gynecologic Laparoscopists, the laparoscopic management of ovarian cysts was the third most common procedure reported.1 Technological advances and appropriate training have allowed ovarian cystectomy to be performed laparoscopically. In this review, we assess the best available diagnostic means to select cases suitable for laparoscopic ovarian cystectomy to prevent inadvertent rupture of ovarian malignancy and to appraise the consequences of rupture of ovarian malignancy if it occurs. Diagnostic Tests and Selection of Patients History and Physical ExaminationHistorically, ovarian cancer has been described as occult disease with an insidious onset of nonspecific symptomatology. A disease of older age, the risk of ovarian malignancy is 12.1 times greater for the 60-69-year age range as compared with the 20-29-age range.2 And the overall risk of malignancy in an ovarian neoplasm increases from 13% in premenopausal women to 45% in postmenopausal women. The use of a physical examination to differentiate benign from malignant disease is based upon certain characteristics, including bilaterality, presence of cystic/solid components, mobility of the pelvic structures, irregularity of the cyst surface, ascites and cul-de-sac nodularity.3 However, these characteristics are nonspecific and some (cystic/solid components or irregularities of the cyst) are best addressed ultrasonographically. Tumor MarkersCirculating tumor markers are used increasingly in the diagnosis and management of gynecologic malignancy. A detailed discussion of tumor markers is beyond the focus of this review. The most commonly used marker for epithelial ovarian cancer is CA 125, a tumor-associated antigen that can be recognized by the specific monoclonal antibody and that is present in 80% of all patients with ovarian cancer. Forty percent of women with Stage I ovarian cancer will have elevated levels. 4 However, it can also be elevated in other physiological circumstances (menstruation and early pregnancy), in benign gynecologic conditions (endometriosis) and with other malignancies (pancreas, stomach, colon and rectum).To use CA 125 for identifying malignant pelvic masses, O'Connell et al. constructed a receiver operator characteristic (ROC) curve and determined that a cutoff of 35 U/mL achieves a sensitivity of 100%, a negative predictive value of 100%, a specificity of 43% and a positive predictive value of 60%. 5 The ROC curve describes the accuracy of a test over a range of cutoff points by depicting the tradeoff between sensitivity and specificity. It can also compare the validity of different diagnostic tests. In this series, however, it is necessary to consider the possibility of selection bias because of the high clinical suspici...

Intraoperative Rupture of the Ovarian Capsule in Early-Stage Ovarian Cancer

“…Thirty-eight of these studies were excluded due to a lack of comparison of progression-free survival or overall survival between the intraoperative capsule rupture and no capsule rupture groups (19 studies), incorrect study type according to our inclusion criteria (13 studies), incorrect population (three studies), incorrect intervention (two studies), and duplicate populations (one study). 6,16–52 The data quality of the remaining articles was assessed using the Newcastle-Ottawa Scale (Appendix 2, available online at http://links.lww.com/AOG/C345). Seventeen studies met all the criteria for inclusion in our meta-analysis.…”