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

P Laven*, J J Beltman, J E Bense, M A van der Aa, T Van Gorp, M C Vos, D Boll, Hgj Arts, N Reesink, J B Trimbos, Rfpm Kruitwagen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)6-11
Number of pages6
JournalSurgery Open Science
Volume7
DOIs
Publication statusPublished - Jan 2022

Keywords

  • ADJUVANT CHEMOTHERAPY
  • CARCINOMA
  • IMPACT
  • Lymph nodes
  • Ovarian cancer
  • Staging
  • Surgical oncology

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