Laparotomy to complete staging of presumed early ovarian cancer

Objective: To assess the findings and complications of laparotomies for completely staging presumed early-stage ovarian cancer in patients whose initial surgery was inadequate. Methods: Records of 45 patients surgically restaged at our institution, after having been incompletely staged elsewhere, were reviewed for original operative reports, pathologic diagnoses, restaging procedures, operative results, and perioperative complications. Results: Initial clinical staging was IA, 28; IB, three; IC, 12; IIA, one; IIB, one. Histologic distribution was as follows: invasive epithelial, 19 (42%); borderline epithelial, 16 (36%); germ cell tumor, seven (16%); and stromal tumor, three (6%). Seven of the 45 patients (16%) had their disease reclassified to a more advanced stage. Of patients with borderline ovarian tumors, two, initially staged as IA, were restaged to IB and IC, and one was restaged from IIB to IIIA. Three patients with invasive epithelial adenocarcinoma were reclassified to a higher stage: one, with a presumed stage IC, poorly differentiated adenocarcinoma, to IIIB; one, with a stage IC, grade 2 mucinous cystadenocarcinoma, to IIIA; and a third, with a IIA, poorly differentiated adenocarcinoma, to IIIC. A patient with granulosa cell tumor, initially staged as IC, was restaged to IIB. Fifteen patients (33%) had complications after restaging surgery. Seven (16%) patients undergoing restaging laparotomy for presumed early ovarian cancer were reclassified to a higher stage, resulting in alteration of treatment for only one patient. In 18 patients with invasive cancer, the second operation confirmed the presence of low-risk stage IA/B disease, allowing adjuvant chemotherapy to be withheld. Conclusion: Although restaging laparotomies provide important prognostic information with minimal morbidity, they provide little benefit to those patients already requiring chemotherapy based on the original operative findings.