Unexpected ovarian malignancy following laparoscopic excision of adnexal masses

Matsushita, Hidenobu; Watanabe, Kazushi; Yokoi, Toyoharu; Wakatsuki, Akihiko

doi:10.1093/humrep/deu162

Cited by 28 publications

(33 citation statements)

References 39 publications

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“…Cerrahları zorlayan en büyük endişe tümörün rüptüre olmasıdır (2,22,38) . Tam kistik kitlelerde yaklaşım yukarıda söz edildiği gibi over koruyucu olmalıdır ve bunlar laparoskopi için son derece uygun olgulardır.…”

Section: Resim 5a Over Torsiyonu (Matür Teratoma Bağlı)unclassified

“…Ancak kistik olduğunu söyleyen radyoloğun ne kadar doğru tanı koyduğundan emin olmak gerekir. USG ve MRI'de kistik olduğu söylenen fakat intraoperatif kistik yapı içinde solid komponentlerle karşılaşılan, beklenmedik over malinansi olgu sayısı az değildir (38) . Büyük over kitlelerinde geleneksel olarak laparotomi önerilmekle beraber, kistin USG eşliğinde veya laparoskopik olarak aspirasyonu sonrası çıkarılması-nı önerenler de vardır.…”

Section: Resim 5a Over Torsiyonu (Matür Teratoma Bağlı)unclassified

“…Kitlenin içinde solid komponent olması maliniteyi düşündüreceğinden yapılacak girişimin şek-lini değiştirecektir. Solid komponent içeren, tümör markerları yüksek ve malinite şüphesi olan kitlelerde laparoskopik olarak eksplorasyon yapılmalı, kitle açılmadan devaskülarize edilerek ooferektomi yapıl-malı, kitle patlatılmadan endobag yardımı ile dışarı alınmalıdır (15,38) (Resim 8). Endobag ile çıkarılamaya-cak kadar büyük kitleler, endobag içinde morselatör yardımı ile parçalanarak çıkarılabileceği gibi laparoskopik olarak serbestleştrildikten sonra, yapılacak kü-çük bir insizyondan dışarı alınabilir.…”

Section: Resim 5a Over Torsiyonu (Matür Teratoma Bağlı)unclassified

“…Aksi taktirde, evre I tümörü evre III haline getirmiş oluruz. Müsinöz kist adenomların içindeki jelatinöz materyalin karın içine yayılması sonucu "psödomiksoma peritonei" denilen tablo gelişir (7,38) .…”

Section: Resim 5a Over Torsiyonu (Matür Teratoma Bağlı)unclassified

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Laparoscopic approach to ovarian masses

Günaydın¹

2016

Tccd

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ÖzAdneksiyal kitleler, çocukluk çağında görülen kitlelerin [1][2] GirişAdneksial kitleler, çocukluk çağında görülen kitlelerin %1-2'sini oluşturur. Bunların % 60-70'i over kaynaklı olup, çoğunlukla basit kistlerdir ve % 97'si benindir (1)(2)(3)(4) . Over kitleleri benin ve malin kitleler olarak kabaca ikiye ayrılır. Benin kitleler arasında folikül kisti, korpus luteum kisti gibi disfonksiyonel kistler, seröz-müsinöz kistadenom gibi benin epitelyal neoplastik kistler, fibroma, tekoma gibi benin solid tümör-ler, paraovarian kistler ve tubo-ovarian abseler akla gelir. Malin kitleler ise epitelyal, germ hücreleri ve sex-cord stromal kaynaklı tümörlerdir (1,2,(4)(5)(6)(7) .Minimal invazif cerrahi, günümüzde yaygın olarak uygulanan, robotik cerrahinin de gelişmesi ile geleceğin cerrahisi olma yolunda büyük ilerleme kaydeden cerrahi yaklaşımdır. Geçmişte, jinekolojide laparoskopi, tanısal amaçlı ve tüp ligasyonu ile sınırlıyken, günümüzde laparoskopik minimal invazif girişimler-deki ilerlemeye paralel olarak jinekolojide de kullanı-mı ve girişim çeşidi artmıştır. Bu bağlamda, konumuz olan çocuklarda over kitlelerine minimal invazif yaklaşım da kabul görmüş ve hemen her çocuk cerrahisi kliniğinde uygulanır hale gelmiştir. Bu yazıda over kitlelerinin tanı ve tedavisinde laparoskopik yaklaAlındığı tarih: 07.03.2016

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Section: Resim 5a Over Torsiyonu (Matür Teratoma Bağlı)unclassified

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Laparoscopic approach to ovarian masses

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2016

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“…A recent study carried out in a Japanese teaching hospital, aimed to determine the frequency of unexpected ovarian malignancy and whether it affects prognosis [5]. It involved a retrospective review of the pathology reports of 884 patients who underwent laparoscopic resection of adnexal masses.…”

Section: Pain (Pelvic And/or Abdominal Pain)mentioning

confidence: 99%

Untitled

2014

OGIJ

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In this review, we will critically evaluate the evolution of the diagnostic tools used in the prediction of ovarian malignancy preoperatively, that has shown to get a better outcome for ovarian cancer patients. It will triage women to the best place for their surgery and by ensuring the expertise available to perform the surgery reducing the rate of incomplete primary surgery, that has reflected into improve survival of ovarian cancer patients.The Risk of Malignancy Index (RMI) was the first diagnostic tool developed to help clinicians differentiate between benign and malignant ovarian tumours. Jacob et al.[1] described how it was developed and assesses its performance amongst a cohort 143 patients referred to a London hospital for elective surgical investigation of an adnexal mass. Each patient had five criteria assessed preoperatively: age, menopausal status, and clinical impression score (as determined by an experienced gynaecologist using all of the patient's preoperative clinical information; out of 5, high = more likely to be malignant), ultrasound score (out of 5, high = more likely to be malignant), and CA-125 level.Following surgery, it was determined that 101 of the patients had benign masses and 42 had malignant tumours. Patients in the malignant group had a higher mean age, were more commonly post-menopausal, and had higher clinical impression scores, ultrasound scores and CA-125 levels than patients in the benign group; all of these differences were statistically significant. However, when used individually, the criteria had inadequate sensitivity and specificity for malignancy.Logistic regression analysis revealed that only menopausal status, ultrasound score and CA-125 levels were significantly and independently related to the likelihood ratio for malignancy. These three criteria were then combined to form the RMI: RMI = U × M × CA-125 U = 0 for ultrasound score of 0 = 1 for ultrasound score of 1 = 3 for ultrasound score of 2-5 M = 1 if premenopausal = 3 if postmenopausal When a cutoff score of 200 was used, the RMI showed excellent diagnostic performance, with a sensitivity of 85% and a specificity of 97%. Patients with an RMI score in excess of 200 had 42 times the background risk of cancer, whilst those with a score less than 200 had 0.15 times the risk. The authors concluded that the RMI was a valuable tool for the preoperative assessment of benign and malignant adnexal masses, and that it gave a higher level of discrimination than could be achieved by individual criteria alone.Overall, this is a good study. The sample size was sufficiently large to allow statistically significant differences between groups to be seen. The criteria used for the RMI were not chosen at

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Outcome and prognostic factors of unexpected ovarian carcinomas

et al. 2022

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Background We investigated risk factors influencing the outcome of unexpected ovarian carcinomas. Methods We reviewed the ovarian carcinoma patients treated at atertiary medical institution between 2000 and 2017 and analyze the clinico‐pathological characteristics, treatment strategies, recurrence status, and outcome. Results A total of 112 women (65 primary laparoscopic surgery [LSC] and 47 laparotomic surgery [LAPA]) were included in the analysis. The LSC group had smaller ovarian tumors (10.5 ± 7.3 cm vs. 16.6 ± 8.7 cm, p = 0.031) and higher incidence of subsequent staging surgery (56.9% vs. 25.5%, p = 0.0001) compared to the LAPA group. There were 98/112 (86.6%) of early stages (I/II) diseases. The difference between the recurrent rate (27.7% vs. 31.9%), disease‐free survival (DFS), and overall survival (OS) were not significant among surgical groups. In the multivariate analysis, FIGO stage (stage II hazard ratio [HR] 6.61, p = 0.007; stage III HR 8.40, p = 0.002) was the only prognostic factor for DFS. FIGO stage (stage II HR 20.78, p = 0.0001; stage III HR 7.99, p = 0.017), histological type (mucinous HR 12.49, p = 0.036), and tumor grade (grade 3 HR 35.01, p = 0.003) were independent prognostic factors for OS, while women with latency >28 days from primary to staging surgery had significantly poorer OS ( p = 0.008). Women with latency >28 days between primary surgery and adjuvant chemotherapy had similar DFS ( p = 0.31) and a trend of poorer OS ( p = 0.064). Conclusions The prognosis of unexpected ovarian cancer is independent from the primary surgical procedure and comprehensive staging surgery should be performed at close proximity after the diagnosis of unexpected ovarian malignancy.

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Unexpected ovarian malignancy following laparoscopic excision of adnexal masses

Cited by 28 publications

References 39 publications

Laparoscopic approach to ovarian masses

Laparoscopic approach to ovarian masses

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Outcome and prognostic factors of unexpected ovarian carcinomas

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