Should adnexal mass size influence surgical approach? A series of 186 laparoscopically managed large adnexal masses

Objective To evaluate the feasibility and safety of laparoscopic management of adnexal masses >= 10 cm in size. Design Prospective cohort study. Setting Two Gynecology Departments of University Hospitals. Population All women presenting with an adnexal mass >= 10 cm in diameter were candidates for laparoscopic management. Women were excluded from laparoscopic approach if there was evidence of ascites or gross metastatic disease. Neither the sonographic features of the cyst nor elevated serum CA125 level was used to exclude women from having a laparoscopic approach. Methods A single operative protocol was followed for all women. All removed specimens were sent for immediate pathological evaluation. Main outcome measures Rate of conversion to laparotomy, incidence of cancer encountered, and operative complications. Results One hundred and eighty-six women underwent laparoscopic evaluation for an adnexal mass of 10 cm or larger in size. The average preoperative mass size was 12.1 +/- 4.9 cm. A benign pathological condition was found in 86.6% (161/186) of the women, primary ovarian cancer in 16 (8.6%) women, a metastatic tumour of gastrointestinal origin in 1 (0.5%) woman, and a low malignant potential ovarian tumour in 8 (4.3%) women. Laparoscopic management was successful for 174 (93.5%) women. Reasons for conversion to laparotomy included anticipated technical difficulty (n = 7) and malignancy (n = 5). No intraoperative complications occurred in the entire study group. Conclusions The vast majority of large adnexal masses can be safely resected laparoscopically, provided that there is expertise in laparoscopic surgery, immediate access to frozen section diagnosis, and preparation of patient to receive an adequate cancer surgery where indicated.