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  • Title: Surgery of borderline tumors of the ovary: retrospective comparison of short-term outcome after laparoscopy or laparotomy.
    Author: Ødegaard E, Staff AC, Langebrekke A, Engh V, Onsrud M.
    Journal: Acta Obstet Gynecol Scand; 2007; 86(5):620-6. PubMed ID: 17464594.
    Abstract:
    BACKGROUND: Laparoscopic management of borderline ovarian tumors is controversial. OBJECTIVE: To retrospectively compare outcome after surgery by laparoscopy or laparotomy for borderline tumors. METHODS: Ovarian tumors from all women operated at Ullevål University Hospital during a five-year period were re-evaluated histologically. Patients with borderline FIGO (International Federation of Gynaecology and Obstetrics) stage I tumors were retrospectively compared regarding surgery outcome following laparoscopy or laparotomy. RESULTS: Histological re-evaluation revealed only 3 misclassifications in 608 patients. Borderline tumors represented 36% of epithelial ovarian malignancies. The 107 borderline stage I included 52 serous, 53 mucinous, and 2 endometrioid tumors. Thirty-eight patients were operated on primarily by laparoscopy and 69 by laparotomy (including 14 women starting with laparoscopy). In the laparoscopy group, more women were premenopausal (63% versus 35%, p=0.01) and median tumor diameter was smaller (8.6 versus 16.4 cm, p<0.001) as compared to the laparotomy group. When tumor diameter exceeded 10 cm, intraoperative tumor rupture was significantly more frequent during laparoscopy than during laparotomy (p=0.01). Less postoperative complications were seen after laparoscopic operations (p=0.034), but laparoscopic surgeries were less extensive, without hysterectomy, as compared to laparotomy. During the 14-78 months follow-up time, no relapse occurred in either group. After fertility-sparing surgery, there was no statistical significant difference regarding successful pregnancies between the two groups. CONCLUSIONS: Laparoscopic treatment of borderline ovarian tumors is feasible if tumor is of moderate size (diameter below 10 cm), gives fewer complications, and shorter hospital stay. Long-term follow-up of larger materials is needed to determine the ultimate recurrence risk as well as fertility rates.
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