Abstract
Surgical exploration of an adnexal mass for the management of pelvic pain or to exclude malignancy is a common gynecologic procedure. While most adnexal masses are benign in nature, all surgeons performing pelvic surgery should understand the surgical recommendations of how to proceed when an ovarian neoplasm is identified. Appropriate pre-operative assessment can help to best identify patients at high-risk of malignancy to ensure appropriate consultation with a gynecologic oncologist. With the evolution of laparoscopy, most adnexal mass surgeries can be performed using minimally invasive surgical techniques. As a guiding principle, all adnexal mass surgery should abide by principles of ovarian cancer staging until malignancy is disproven.
Keywords: Adnexal mass, ovary, ovarian cancer, laparoscopy, surgery, serum tumor marker.
Graphical Abstract
[2]
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstet Gynecol 2016; 128(5): e210-6.
[3]
Giede KC, Kieser K, Dodge J, Rosen B. Who should operate on patients with ovarian cancer? An evidence-based review. Gynecol Oncol 2005; 99(2): 447-61.
[4]
Mercado C, Zingmond D, Karlan BY, et al. Quality of care in advanced ovarian cancer: the importance of provider specialty. Gynecol Oncol 2010; 117(1): 18-22.
[5]
Vernooij F, Heintz P, Witteveen E, van der Graaf Y. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol 2007; 105(3): 801-12.
[6]
American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol 2011; 117(3): 742-6.
[7]
Kushnir CL, Diaz-Montes TP. Perioperative care in gynecologic oncology. Curr Opin Obstet Gynecol 2013; 25(1): 23-8.
[8]
Guenaga KF, Matos D, Wille-Jorgensen P. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev 2011; (9): CD001544.
[9]
ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113(5): 1180-9.
[10]
Committee on Practice Bulletins--Gynecology ACoO. Gynecologists. ACOG Practice Bulletin No. 84: Prevention of deep vein thrombosis and pulmonary embolism. Obstet Gynecol 2007; 110(2 Pt 1): 429-40.
[11]
Yuen PM, Yu KM, Yip SK, Lau WC, Rogers MS, Chang A. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol 1997; 177(1): 109-14.
[12]
Deckardt R, Saks M, Graeff H. Comparison of minimally invasive surgery and laparotomy in the treatment of adnexal masses. J Am Assoc Gynecol Laparosc 1994; 1(4 Pt 1): 333-8.
[13]
Argenta PA, Nezhat F. Approaching the adnexal mass in the new millennium. J Am Assoc Gynecol Laparosc 2000; 7(4): 455-571.
[14]
Fanfani F, Fagotti A, Ercoli A, et al. A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses. Hum Reprod 2004; 19(10): 2367-71.
[15]
Kehoe S, Hook J, Nankivell M, et al. Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet 2015; 386(9990): 249-57.
[16]
Gill SE, McGree ME, Weaver AL, Cliby WA, Langstraat CL. Optimizing the treatment of ovarian cancer: Neoadjuvant chemotherapy and interval debulking versus primary debulking surgery for epithelial ovarian cancers likely to have suboptimal resection. Gynecol Oncol 2017; 144(2): 266-73.
[17]
Davidson W, Madan R, O’Neil M, Tawfik OW, Fan F. Utility of peritoneal washing cytology in staging and prognosis of ovarian and fallopian tube neoplasms: a 10-year retrospective analysis. Ann Diagn Pathol 2016; 22: 54-7.
[18]
Creasman WT, Rutledge F. The prognostic value of peritoneal cytology in gynecologic malignant disease. Am J Obstet Gynecol 1971; 110(6): 773-81.
[19]
Prat J. FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet 2014; 124(1): 1-5.
[20]
Bakkum-Gamez JN, Richardson DL, Seamon LG, et al. Influence of intraoperative capsule rupture on outcomes in stage I epithelial ovarian cancer. Obstet Gynecol 2009; 113(1): 11-7.
[21]
Zuna RE, Behrens A. Peritoneal washing cytology in gynecologic cancers: long-term follow-up of 355 patients. J Natl Cancer Inst 1996; 88(14): 980-7.
[22]
Kondo W, Bourdel N, Cotte B, et al. Does prevention of intraperitoneal spillage when removing a dermoid cyst prevent granulomatous peritonitis? BJOG 2010; 117(8): 1027-30.
[23]
Fauvet R, Boccara J, Dufournet C, Poncelet C, Darai E. Laparoscopic management of borderline ovarian tumors: results of a French multicenter study. Ann Oncol 2005; 16(3): 403-10.
[24]
Park JY, Bae J, Lim MC, et al. Laparoscopic and laparotomic staging in stage I epithelial ovarian cancer: a comparison of feasibility and safety. Int J Gynecol Cancer 2008; 18(6): 1202-9.
[25]
Havrilesky LJ, Peterson BL, Dryden DK, Soper JT, Clarke-Pearson DL, Berchuck A. Predictors of clinical outcomes in the laparoscopic management of adnexal masses. Obstet Gynecol 2003; 102(2): 243-51.
[26]
Gad MS, El Khouly NI, Soto E, et al. Differences in perioperative outcomes after laparoscopic management of benign and malignant adnexal masses. J Gynecol Oncol 2011; 22(1): 18-24.
[27]
Gal D, Lind L, Lovecchio JL, Kohn N. Comparative study of laparoscopy vs. laparotomy for adnexal surgery: efficacy, safety, and cyst rupture. J Gynecol Surg 1995; 11(3): 153-8.
[28]
Blanc B, Boubli L, D’Ercole C, Nicoloso E. Laparoscopic management of malignant ovarian cysts: a 78-case national survey. Part 1: Pre-operative and laparoscopic evaluation. Eur J Obstet Gynecol Reprod Biol 1994; 56(3): 177-80.
[29]
Vergote I, De Brabanter J, Fyles A, et al. Prognostic importance of degree of differentiation and cyst rupture in stage I invasive epithelial ovarian carcinoma. Lancet 2001; 357(9251): 176-82.
[30]
Dembo AJ, Davy M, Stenwig AE, Berle EJ, Bush RS, Kjorstad K. Prognostic factors in patients with stage I epithelial ovarian cancer. Obstet Gynecol 1990; 75(2): 263-73.
[31]
Sjovall K, Nilsson B, Einhorn N. Different types of rupture of the tumor capsule and the impact on survival in early ovarian carcinoma. Int J Gynecol Cancer 1994; 4(5): 333-6.
[32]
Mizuno M, Kikkawa F, Shibata K, et al. Long-term prognosis of stage I ovarian carcinoma. Oncology 2003; 65(1): 29-36.
[33]
Sainz de la Cuesta R, Goff BA, Fuller AF Jr, Nikrui N, Eichhorn JH, Rice LW. Prognostic importance of intraoperative rupture of malignant ovarian epithelial neoplasms. Obstet Gynecol 1994; 84(1): 1-7.
[34]
Kochli OR, Schnegg MP, Muller DJ, Surbek DV. Endobag extractor to remove masses during laparoscopy. Obstet Gynecol 2000; 95(2): 304-5.
[35]
Heatley MK. A systematic review of papers examining the use of intraoperative frozen section in predicting the final diagnosis of ovarian lesions. Int J Gynecol Pathol 2012; 31(2): 111-5.
[36]
Geomini P, Bremer G, Kruitwagen R, Mol BW. Diagnostic accuracy of frozen section diagnosis of the adnexal mass: a metaanalysis. Gynecol Oncol 2005; 96(1): 1-9.
[37]
Usubutun A, Altinok G, Kucukali T. The value of intraoperative consultation (frozen section) in the diagnosis of ovarian neoplasms. Acta Obstet Gynecol Scand 1998; 77(10): 1013-6.
[38]
Tempfer CB, Polterauer S, Bentz EK, Reinthaller A, Hefler LA. Accuracy of intraoperative frozen section analysis in borderline tumors of the ovary: a retrospective analysis of 96 cases and review of the literature. Gynecol Oncol 2007; 107(2): 248-52.
[39]
Abudukadeer A, Azam S, Zunong B, Mutailipu AZ, Huijun B, Qun L. Accuracy of intra-operative frozen section and its role in the diagnostic evaluation of ovarian tumors. Eur J Gynaecol Oncol 2016; 37(2): 216-20.
[40]
Basaran D, Salman MC, Boyraz G, et al. Accuracy of intraoperative frozen section in the evaluation of patients with adnexal mass: retrospective analysis of 748 cases with multivariate regression analysis. Pathol Oncol Res 2015; 21(1): 113-8.
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