Autori: M. Candiani, C. Vasile, M.R Sgherzi, A. Nozza, F. Maggi, R. Maggi

Editorial: Clinical Experimental Obstet.Gynecol, XXVI ,n.1, 1999.

Rezumat:

The management of ovarian borderline tumors represents a puzzling chapter in the treatment of adnexal masses.Laparoscopic treatment of borderline tumors is still experimental and performed in few centers. The Universitary Endoscopic Experimental Center CUCESC – University of Milano started in 1996 a prospective study on laparoscopic management of borderline ovarian tumors in collaboration with other Italian niversities, including the Endoscopic Group of Padova University. This is an ongoing study, the first Italian multicenter study on borderline tumors treated by laparoscopy.From 1993 through 1998, fifty eight (n= 58) patients with borderline ovarian tumors were surgically treated in the 2nd Department of Gynecology of the University of Milano. The mean age of the patients was 42 years (range 19-79) . A total of 70 ovarian cysts (9 bilateral) with a mean cystic diameter of 8.6 cm were present. Twenty six patients ( 44.8%) underwent laparoscopic treatment while 32 (55.17%) underwent laparotomy.The patients in the two groups (laparoscopic and laparotomic) presented a homogeneous distribution regarding age and fertile status.Conservative treatment was performed in 32 patients ( 55.17% ) – laparoscopically in 19 cases and by laparotomy in 13 cases, while demolitive procedures were carried out in 26 cases (44.8%) – 7 by laparoscopy and 19 by laparotomy. The indication for conservative treatment (cystectomy or monolateral oophorectomy) in the laparoscopy group included stage I borderline ovarian tumors in patients wishing to preserve their fertility. The laparoscopy group ( n= 26 ) included 17 stage IA (65.3 %) , 2 stage IB ( 7.6% ),and 6 stage IC (23.07%) patients – the prevalence of initial stages was 96.15 % and conservative treatment was carried out in 73.07% of the cases. Our data reveal that in the laparoscopy group the conservative approach was more frequent but this was due to the higher incidence of initial stages in these patients . Considering only stage IA patients ,10 out of 17 (58.8% ) in the laparoscopy group and 8 out of 15 ( 53.3%) in the laparotomy one had conservative surgery, therefore the two groups may be considered homogeneous with regard to the type of surgical approach. The mean follow up was 64 months. Fifty seven patients are alive with no evidence of disease, one NED patient died for other reasons Eighteen patients out of 32 who had had conservative surgery underwent a second look laparoscopy ; in 5 cases ( 15.6% ) persistence or recurrence of the disease was found and subsequently treated conservatively in 4 cases.
8 women became pregnant after conservative surgery.
One pregnant patient with borderline ovarian tumor was laparoscopically treated. To the best of our knowledge this is the first case of borderline ovarian tumor in pregnancy treated by laparoscopy (It J Gynaecol Obstet, vol.10,3 1998).
Borderline ovarian tumors have peculiar clinical and histological characteristics, therefore more than 70%of the patients are in early stages and have good prognosis.The high incidence of these tumors in young patients which desire to preserve their reproductive potential as well as the early stage diagnosis, suggest a conservative surgical approach.

Cuvinte cheie: tunori ovariene borderline,tratament laparoscopic // borderline ovarian tunors,laparoscopic treatment