Laparoscopic fertility-sparing staging in unexpected early stage ovarian malignancies

Objective: To assess feasibility and safety of fertility-sparing laparoscopic staging in women affected by unexpected ovarian cancer desiring to preserve their fertility. Design: Prospective study. Setting: University clinic. Patient(s): Twenty-seven patients already operated on elsewhere for a presumably benign ovarian cyst. Intervention(s): Laparoscopic fertility-sparing staging operations. Main Outcome Measure(s): Perioperative and survival data, reproductive outcome. Result(s): Histologic findings after first surgery: 12 low malignant potential neoplasms, 11 invasive epithelial ovarian carcinomas, 1 sex-cord stromal, and 3 germ cell neoplasms. Fertility-sparing staging consisted of exploration of the peritoneal cavity, peritoneal washing cytology, multiple peritoneal biopsies, omolateral adnexectomy (except in borderline tumors), omentectomy, omolateral or bilateral pelvic and aortic lymph node sampling (except in borderline tumors, well differentiated, mucinous, and granulosa cell (GC) neoplasms), endometrial biopsy, appendectomy in mucinous type. Overall, seven patients (26%) were upstaged. Six patients received adjuvant platinum-based chemotherapy. Two term pregnancies occurred. After a median follow-up of 20 months all patients are alive; one patient has FIGO stage Ic, clear cell carcinoma, which recurred 8 months after surgery. Conclusion(S): Laparoscopic fertility-sparing staging in early ovarian malignancies is feasible and safe in selected and counseled patients and should be performed in experienced gynecological oncology centers trained in endoscopic procedures. (Fertil Steril (R) 2009;91:2632-7. (C)2009 by American Society for Reproductive Medicine.)