Abstract

LAPAROSCOPIC PRACTICE IN OVARIEN TUMOR

S. Benbouchaib, R. Samhari, M. Mourabbih*, M. Ennachit, M. Benhassou and M. El Karroumi

Abstract

Adnexal masses are common in women of all ages, and up to 10% of these women will undergo surgical removal of an ovarian mass. Surgical management of adnexal masses is rendered more complex by the lack of a preoperative test that can definitively exclude underlying malignancy, and concerns remain about intraoperative rupture of an occult malignancy and subsequent dissemination of cancer. However the oncologic surgical principles must be always followed even in those whose mass has low suspicion for malignancy, and the surgical technique must be adapted to the characteristics of the cyst and the patient. Laparoscopy is increasingly being viewed as the preferred surgical approach for management of these masses. Contraindications to laparoscopy are few, and multiple studies have shown benefits over laparotomy with respect to length of hospital stay, complications, and pain. Large case series have documented the safety and efficacy of laparoscopic removal of adnexal masses. And it can safely be performed by appropriately trained surgeons in almost all patient populations, including pregnancy and the morbidly obese. Survival rates in patients staged by laparoscopy, most of the retrospective literature reports survival rates of approximately 90% at follow-up, rates similar to that observed in patients staged by laparotomy. Although prospective trials on laparoscopic staging of early ovarian cancer will be a challenge to conduct due to the low prevalence of ovary-confined ovarian cancers, this level of data will be required to understand how laparoscopy impacts cancer recurrence and mortality for this specialized population. Given these clear limitations, proper patient selection and counseling, in addition to careful surgical technique, remains the mainstay of succesful laparoscopic procedure.

Keywords: Casablanca.