Published online Aug 10, 2014. doi: 10.5317/wjog.v3.i3.109
Revised: June 11, 2014
Accepted: July 12, 2014
Published online: August 10, 2014
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Ovarian cancer is one of the most common causes of cancer-related death in women. Adnexal masses are frequently diagnosed during reproductive age and often require surgical removal. The risk of malignancy when dealing with a complex adnexal mass should be defined prior to surgery and several scoring systems may be useful for this purpose. Laparoscopic management of ovarian tumours allows a minimally invasive approach with respect to several oncological assumptions. In the last decade concerns have been raised regarding the risk of cyst rupture and tumour spillage as a consequence of the laparoscopic technique itself both in early and advanced stages of ovarian cancer. Although limited data have been reported in the literature on the use of minimally invasive techniques in ovarian cancer, the clear benefits of this approach must be balanced with the potential hazards in different clinical situations. Laparoscopic staging in borderline tumours and presumed early-stage ovarian cancer performed by a laparoscopic oncologist seems to be safe and effective when compared to laparotomy. The precise role of laparoscopy in patients with more advanced cancer is still to be defined, and the risk of suboptimal surgery should never outweigh the potential benefits of minimally invasive surgery. Thus, a tailored prediction of optimal laparoscopic debulking is mandatory in these patients.
Core tip: The systematization of laparoscopic techniques and the improvement in technology have provided the basis for the increased use of laparoscopy in oncology in the last decade. Preoperative evaluation of complex adnexal masses and surgical planning are key factors in defining the most appropriate tailored therapy for each patient. Herein, we address the limitations and concerns regarding the use of minimally invasive techniques in the treatment of complex adnexal masses and ovarian cancer, including the clinical scenarios of borderline tumours, and both early and more advanced stages of the disease.