Adnexal mass management by minimally invasive surgery at a comprehensive cancer center.

Abstract

This study investigates methods of specimen extraction, pertinent clinical data and pathologic findings associated with minimally invasive surgery (MIS) for adnexal masses. This retrospective cohort study includes patients with an adnexal mass who underwent MIS removal. The association of categorical variables with adverse outcomes was investigated using Pearson chi-square or Fisher's exact test. Four hundred and thirty-eight patients met inclusion criteria. Surgical modalities included laparoscopic (n = 235, 53.7%), robotic (n = 165, 37.7%), and vaginal (n = 1, 0.2%). MIS was converted to laparotomy in 37 cases (8.4%). 203 (46.3%) specimens were removed vaginally, and 235 (53.7%) abdominally. Three hundred and nineteen (72.8%) specimens were removed intact whereas 119 (27.2%) were morcellated or drained 113 contained). Of the 6 uncontained morcellation cases, one was ovarian cancer, and one was a borderline tumor. For malignant histologies, receipt of adjuvant chemotherapy was not associated with specimen integrity (455 intact vs 12 morcellated, p = 0.207), route of specimen removal (31 vaginal vs 36 abdominal, p = 0.217), or use of a specimen bag (46 bag vs 21 no bag, p = 0.105). This study demonstrated that MIS is feasible in the majority of patients referred to our cancer center for an adnexal mass. Perioperative complications were uncommon. Management of the ovarian malignancies encountered in this cohort was not compromised by utilization of MIS.