Abstract
Abstract
Objective:
It is the conventional belief that comprehensive staging of presumed early ovarian cancer results in upstaging of the disease in ∼30% of patients. With the latest developments in modern technology and wider use of diagnostic imaging, the importance of such surgical staging needed prospective evaluation.
Materials and Methods:
This was a prospective cohort study. It was conducted in a tertiary cancer hospital over a period of 18 months, starting in June 2014. All willing women with clinically suspected early stage epithelial ovarian cancer, based on preoperative contrast-enhanced computerized tomography of the abdomen and pelvis and serum CA-125 levels, were included. At laparotomy, the diseased ovary was removed from each patient and sent for frozen- section confirmation for epithelial cancer. Patients with confirmation of epithelial cancer underwent comprehensive surgical staging, including systematic pelvic and para-aortic lymph node dissection (PAND) as prescribed by the International Federation of Gynecology and Obstetrics.
Results:
A total of 42 patients underwent complete surgical staging, of whom 4 were excluded at final analysis. On comprehensive staging, the disease was upstaged in 8 (21%) patients: 4 had retroperitoneal nodal metastases (11%); 2 had paracolic peritoneal involvement (5%); and 2 patients had omental involvement (5%). A mean of 16 pelvic and 13.76 para-aortic nodes were removed. The para-aortic nodes were involved in 3 (75%) of the 4 patients with retroperitoneal nodal involvement. Of the parameters analyzed, no statistically significant factors were found that could have predicted the lymph nodal involvement.
Conclusions:
Comprehensive staging, including systematic PAND, is still the “gold standard” in the management of early stage ovarian cancer. (J GYNECOL SURG 33:184)
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