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Objectives.To evaluate the risk of the laparoscopic approach to patie nts with borderline ovarian tumors compared to the laparotomic management. Methods. We tr eated or followed in our institution 479 women with borderline ovarian tumor. Si xtytwo patients had fertility-sparing surgery followed by restaging or follow- up intervention: 30 operated by laparoscopy, 32 by laparotomy. Restaging surgery was performed in five cases and second-look surgery in 57. Results. The diamet er of the cyst is significantly lower in patients treated by laparoscopy, especi ally in womenwho underwent cystectomy (4.7 cm) compared to oophorectomy (10 cm, P = 0.008). Rupture of the cyst and stage IC were more frequent in the laparosco pic group. After a median follow-up of 61 months for the laparoscopic group and 77 months for the laparotomic group, we observed 11 patients (37%) with persis tent disease after primary laparoscopy (adnexa, five cases; peritoneal implants, three cases; both patterns, three cases). After primary laparotomy, no patients showed early persistence of tumor, and ovarian relapses were diagnosed in seven women (22%) 33-138 months after laparotomy. The univariate analysis for the r isk of neoplastic persistence after primary laparoscopy shows that patients with cysts greater than 5 cm have a higher risk (odds ratio 9.7, P = 0.02) compared to smaller cysts. No other factors proved significant, but the odds ratios for p atients with serous tumor (5.8), stage IC (2.0), and those undergoing cystectomy (1.9) suggest a relationship to the probability of persistence. Conclusion. Lap aroscopic treatment in borderline ovarian tumors should be reserved to masses no t greater than 5 cm. When conservative therapy is desired, the entire affected o vary should be removed. If the neoplasia is bilateral, cystectomy could be allow ed in women who wish to preserve fertility, although they are at high risk of re lapse.
Objectives.To evaluate the risk of the laparoscopic approach to patients with borderline ovarian tumors compared to the laparotomic management. Methods. We tr eated or followed in our institution 479 women with borderline ovarian tumor. Si xtytwo patients had fertility-sparing surgery followed by restaging or follow-up intervention: 30 operated by laparoscopy, 32 by laparotomy. Restaging surgery was performed in five cases and second-look surgery in 57. Results. The diamet er of the cyst is significantly lower in patients treated by laparoscopy, especi ally In womenwho underwent cystectomy (4.7 cm) compared to oophorectomy (10 cm, P = 0.008). After a median follow-up of 61 months for the laparoscopic group and 77 months for the laparotomic group, we observed 11 patients (37%) with persis tent disease after primary laparoscopy (adnexa, five cases; peritoneal implants, three cases; both patterns, three cases s). After primary laparotomy, no patients showed early persistence of tumor, and ovarian relapses were diagnosed in seven women (22%) 33-138 months after laparotomy. The univariate analysis for the r isk of neoplastic persistence after primary laparoscopy shows that patients compared to smaller cysts. no other factors proved significant, but the odds ratios for p atients with serous tumor (5.8), stage IC (2.0), and those undergoing cystectomy (1.9) suggest a relationship to the probability of persistence. Conclusion. Laparoscopic treatment in borderline ovarian tumors should be reserved to mass no t greater than 5 cm. When conservative therapy is desired, the entire affected o vary should be if the neoplasia is bilateral, cystectomy could be allow ed in women who wish to preserve fertility, although they are at high risk of re lapse.