Laparoscopic evaluation and management of adnexal masses and ovarian cancer

Introduction The American Cancer Society estimates that 21,990 women will be diagnosed with ovarian cancer and 15,460 will die of the disease in 2011 [1]. Of these 21,990 patients, 20% will have stage I disease, for which 5-year survival rates approach 90%. However, numerous studies have shown that a significant percentage of patients with apparent early stage (stage I) ovarian cancer actually harbor microscopic metastatic disease. Consequently, the benefits of surgical staging for epithelial ovarian carcinoma have been well established. Traditionally, it has been recommended that a comprehensive surgical staging procedure for epithelial ovarian and fallopian tube cancers include a total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal cytologic washings, biopsies of adhesions and peritoneal surfaces, omentectomy, and retroperitoneal lymph node sampling from the pelvic and para-aortic regions through a generous vertical midline laparotomy incision [2]. With the advent of minimally invasive surgical techniques, surgeons are now able to perform all of the necessary procedures for comprehensive surgical staging, including pelvic and para-aortic lymphadenectomies and omentectomies, using conventional videolaparoscopy or robotic-assisted videolaparoscopy in selected patients.