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Re: Ovarian Cyst: Laparoscopy vs. conventional surgeryFrom: William D. McIntosh, MD (anonymous@obgyn.net)Sat, 27 Feb 1999 13:31:56 -0600 (CST)
At Fri, 26 Feb 1999, Chuck wrote: > >Ten years ago my wife had a benign, grapefruit sized ovarian cyst >removed, along with her left ovary & fallopian tube. Now, three >children later, at age 34 she has an 11 cm cyst on her right ovary. The >doctor says that it is likely benign and suggested laparoscopy. He said >that if the cyst turned out to be malignant cancer cells might spill out >into the abdominal cavity. Is this a real enough concern which should >outweigh the benefits of laparoscopy or is the good doctor just covering >his bases? He said that if there were any indications that it were not >benign, he would not have counseled her about laparoscopy. Are there >statistics which address the risk factor here? > >Thanks for your help > >-- >Chuck Bennett > This is an issue that causes considerable controversy within surgical circles. Gyn oncologists, who primarily deal with cancer, don't like laparoscopy for ovarian masses, because they are conditioned to see cancer until proven otherwise. Good laparoscopic surgeons are conditioned in the other direction. The odds are enormous that the mass you describe is benign, and should therefore be treated as benign, which means the least invasive surgery possible. The common compromise between these 2 positions is to perform a diagnastic laparoscopy, evaluate the mass visually, and then decide if laparoscopic removal is practical and safe. If the appearance of the cyst is benign, and removal via scope reasonable, then you go ahead. If not, then you abort, and switch to an open proceedure. If the tumor is benign, and is filled with either serous or mucinous material, then intraoperative rupture is irrelevant. If the tumor is malignant, then the issue is more cloudy. The presumption would be that the fluid would be contaminated with malignant cells, and that spillage of the fluid would increase the risk of tumor spread. In fact, spillage of fluid influences the cancer stage. However, there is no evidence that operative spillage effects survival. In addition, as our understanding of how ovarian cancer behaves improves, the presumption is increasingly that tumor cells are already disseminated in the abdomen whether the cyst is open or not. In the end, your choice depends on the chance that the cyst is cancer (small apparently), the laparoscopic surgical skill of her doctor, and whether or not you trust his judgement.
-- William D. McIntosh, MD Clarksville, TN
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