Surgery Open Science (Jan 2022)

Incomplete surgical staging in clinical early-stage ovarian cancer: guidelines versus daily practice

  • P Laven, MD,
  • JJ Beltman, MD, PhD,
  • JE Bense, MD,
  • MA van der Aa, PhD,
  • T Van Gorp, MD, PhD,
  • MC Vos, MD, PhD,
  • D Boll, MD, PhD,
  • HGJ Arts, MD, PhD,
  • N Reesink, MD, PhD,
  • JB Trimbos, MD, PhD,
  • RFPM Kruitwagen, MD, PhD

Journal volume & issue
Vol. 7
pp. 6 – 11

Abstract

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Background: Incomplete surgical staging of patients with early-stage epithelial ovarian cancer (EOC) has been reported in up to 98% of cases, when based on the International Federation of Obstetrics and Gynecology (FIGO) staging procedure. The aim of the present retrospective study was to clarify the reasons for incomplete staging. Methods: The PRISMA (Prevention Recovery Information System for Monitoring and Analysis) technique was used to evaluate cases with FIGO I-IIa EOC based on incomplete staging from five gynecologic oncologic center hospitals in the Netherlands in the period 2010–2014. Results: Fifty cases with an incomplete surgical staging of EOC according to national guidelines were included. The most common reasons for incomplete staging were insufficient random biopsies of the peritoneum (n = 34, 68%), and less than ten lymph nodes being resected and/or found at pathology (n = 16, 32%). The most mentioned reason for not performing biopsies was, besides forgetting to do so, believing that after careful inspection and palpation, taking biopsies is irrelevant and/or already are being taken while performing a hysterectomy (peritoneum of cul-de-sac, bladder). The value of contralateral pelvic lymph node dissection in case of a unilateral ovarian malignancy was also doubted, influencing the number of lymph nodes resected. Conclusions: The most important reasons for incomplete staging in EOC are, besides omitting elements by accident, questioning the importance of obligatory elements of the staging procedure. A structured list of staging steps during surgery and more evidence-based consensus concerning these obligatory elements might increase the number of complete staging procedures in EOC.

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