Role of Laparoscopy

Historically, laparoscopy was indicated for patients with apparent early-stage disease who had been inadequately staged. In their report, Childers and associates68 upstaged eight of their 14 patients with apparent early stage disease who underwent laparo-scopic staging. Leblanc and associates69 reported on a series of 29 patients with invasive epithelial ovarian tumors who underwent laparoscopic staging. Laparoscopic staging was successfully completed in all but one case. Four of 29 (13.7%) patients were upstaged after laparoscopic staging. With a median follow-up of 59 months, no long-term complications (including port site recurrences) were observed, and the 5-year disease-free and overall survival were 90.6% and 92.6% respectively.69 Similarly in their series of 11 patients, Tozzi and colleagues70 observed only two recurrences without any port site metastasis after a median follow-up of 46 months. Chi and associates71 reported the first case-control study comparing 20 patients with early-stage ovarian cancer staged by laparoscopy versus 30 patients who were staged by laparotomy. The number of nodes and omentum size were similar in both groups with fewer complications and shorter postoperative stay in spite of a longer operative room time for the laparoscopic group. The series also included seven patients who were fully managed laparoscopically after the frozen-section analysis of the affected adnexa (Table 7-3).

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