Laparoscopic restaging of borderline ovarian tumours (BLOT): a retrospective study of 142 cases

Abstract

Primary objective: To analyse the impact of restaging, on recurrences and survival, in BLOT.

Secondary objective: To cluster patients who could be exempted from restaging.

Study design: This retrospective study, included patients operated for a BLOT, between January 1990, and December 2007, in gynaecological surgery units of the University Hospital of Clermont-Ferrand. Two groups were evaluated: patients with and without optimal restaging.

Results: One hundred and forty-two patients were included. Optimal initial staging rate was 38.7% (n=55). Among the eighty-seven women not initially staged, two groups were compared: restaged (n=45) and non-restaged patients (n=42). Mean follow-up was 80.5 months. Overall survival was 93.7%. Relapse rate was 7.7% (n=11). Disease free survival (DFS) was 88% after a mean follow-up of 80.5 months. One death was noted. Optimal restaging rate was 31.7% (n=45, 43 by laparoscopy). Mean follow-up was of 87.1 months among restaged patients, 84.5 months among non-restaged patients (p=0.93). Relapse incidence was significantly higher in non restaged, than in restaged patients (p=0.008). DFS was significantly longer among restaged than non-restaged patients, (p=0.072). Younger age (p=0.04), conservative treatment (p<10(-4)) or non-diploidy (p=0.04) increased the incidence of relapse.

Conclusions: When initial staging is missing, restaging improves the patients outcome in comparison to non-restaged groups. Laparoscopy is a valuable surgical option. This study suggests that a selected group of patients, older than 30 years old, submitted to a radical treatment, presenting a diploid, non micropapillar, mucinous BLOT, without visible implants during careful peritoneal inspection, could be exempted from restaging. They represented 11.6% of our population.