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Laparoscopic Management of Early-Stage Malignant Nonepithelial Ovarian Tumors: Surgical and Survival Outcomes

Shim, Seung-Hyuk MD; Kim, Dae-Yeon MD, PhD; Lee, Shin-Wha MD, PhD; Park, Jeong-Yeol MD, PhD; Kim, Jong-Hyeok MD, PhD; Kim, Yong-Man MD, PhD; Kim, Young-Tak MD, PhD; Nam, Joo-Hyun MD, PhD

International Journal of Gynecological Cancer: February 2013 - Volume 23 - Issue 2 - p 249–255
doi: 10.1097/IGC.0b013e318272e754
Ovarian Cancer

Objective: Laparoscopic management in patients with malignant nonepithelial ovarian tumors (MNEOTs) was unpopular owing to the solid nature and relatively large size of the tumors. The purpose of this study was to evaluate the role of laparoscopy for MNEOTs.

Methods: Between January 1989 and September 2010, 28 patients with MNEOTs underwent laparoscopic surgery at our institution. These patients’ clinicopathologic data were retrospectively reviewed from medical records.

Results: Cases included 20 sex cord–stromal tumors (18 granulosa cell and 2 Sertoli-Leydig cell) and 8 malignant germ cell tumors (4 dysgerminomas, 2 immature teratomas, 1 choriocarcinoma, and 1 yolk sac tumor). The patients’ median age was 27 years (range, 16–35 years) for those with malignant germ cell tumors and 42 years (range, 7–57 years) for those with stromal tumors. The median primary tumor diameter was 10.4 cm (range, 3.3–20.8 cm). Laparoscopic pelvic and para-aortic lymph node dissections were performed in 9 cases. Laparoscopic removal of primary tumor and omentectomy were performed in 26 and 6 cases, respectively. Hand-assisted laparoscopic surgery was performed for one huge tumor that could not be entered into the endobag. The median operating time was 102 minutes (range, 45–300 minutes), and the median postoperative hospital stay was 3 days (range, 2–10 days). All patients had stage I disease. Five patients received adjuvant chemotherapy, and the median interval to chemotherapy was 14 days (range, 2–21 days). No intraoperative complication or conversion to laparotomy was observed. Only one postoperative febrile morbidity occurred. The median follow-up was 34.5 months (1–185 months). One patient developed recurrence, which was treated with chemotherapy. No patient died of their disease.

Conclusion: This is the first case series report of laparoscopic surgery for MNEOTs. Laparoscopic management seems feasible and safe without compromising survival. With additional evidence, laparoscopic surgery could be a safe therapeutic option for management of early-stage MNEOTs.

Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Address correspondence and reprint requests to Dae-Yeon Kim, MD, PhD, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea. E-mail: kdyog@amc.seoul.kr.

The authors declare no conflicts of interest.

Received June 8, 2012

Accepted Sept 5, 2012

Copyright © 2013 by IGCS and ESGO