Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Long text of the Joint French Clinical Practice Guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Part 1: Diagnostic exploration and staging, surgery, perioperative care, and pathology

J Gynecol Obstet Hum Reprod. 2019 Jun;48(6):369-378. doi: 10.1016/j.jogoh.2019.03.017. Epub 2019 Mar 30.

Abstract

An MRI is recommended for an ovarian mass that is indeterminate on ultrasound. The ROMA score (combining CA125 and HE4) can also be calculated (grade A). In presumed early-stage ovarian or tubal cancers, the following procedures should be performed: an omentectomy (at a minimum, infracolic), an appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C), and pelvic and para-aortic lymphadenectomies (grade B) for all histologic types, except the expansile mucinous subtypes, for which lymphadenectomies can be omitted (grade C). Minimally invasive surgery is recommended for early-stage ovarian cancer, when there is no risk of tumor rupture (grade B). For FIGO stages III or IV ovarian, tubal, and primary peritoneal cancers, a contrast-enhanced computed tomography (CT) scan of the thorax/abdomen/pelvis is recommended (grade B), as well as laparoscopic exploration to take multiple biopsies (grade A) and a carcinomatosis score (Fagotti score at a minimum) (grade C) to assess the possibility of complete surgery (i.e., leaving no macroscopic tumor residue). Complete surgery by a midline laparotomy is recommended for advanced ovarian, tubal, or primary peritoneal cancer (grade B). For advanced cancers, para-aortic and pelvic lymphadenectomies are recommended when metastatic adenopathy is clinically or radiologically suspected (grade B). When adenopathy is not suspected and when complete peritoneal surgery is performed as the initial surgery for advanced cancer, the lymphadenectomies can be omitted because they do not modify either the medical treatment or overall survival (grade B). Primary surgery (before other treatment) is recommended whenever it appears possible to leave no tumor residue (grade B).

Keywords: Chemotherapy; Guidelines; Ovarian cancer; Primary peritoneal cancer; Surgery; Tubal cancer.

Publication types

  • Practice Guideline

MeSH terms

  • Biomarkers, Tumor / blood
  • Fallopian Tube Neoplasms / diagnosis*
  • Fallopian Tube Neoplasms / pathology
  • Fallopian Tube Neoplasms / surgery*
  • Female
  • France
  • Humans
  • Laparoscopy
  • Magnetic Resonance Imaging
  • Minimally Invasive Surgical Procedures
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Neoplasms, Glandular and Epithelial / diagnosis
  • Neoplasms, Glandular and Epithelial / pathology
  • Neoplasms, Glandular and Epithelial / surgery
  • Ovarian Neoplasms / diagnosis*
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery*
  • Perioperative Care
  • Peritoneal Neoplasms / diagnosis*
  • Peritoneal Neoplasms / pathology
  • Peritoneal Neoplasms / surgery*
  • Tomography, X-Ray Computed

Substances

  • Biomarkers, Tumor