Durán-Colín AA, Ponce-Escobar LF, Silvestri-Tomassoni JR, Olguín-Ortega AA

Language: Spanish
References: 20
Page: 668-675
PDF size: 404.15 Kb.

ABSTRACT

Objetive: The objective of this study is describe the diagnostic approach and the outcomes of patients with a diagnosis of a benign adnexal mass treated by minimally invasive surgery.
Materials and Methods: This is a retrospective study, conducted at the National Institute of Perinatal Medicine. We included all the patients attended between January, 2014 and September, 2015. We retrieved from the files, population general data, data of the surgical procedure, complications and histopathological results. We used descriptive statistic to report everyone of the variables.
Results: We included 104 patients. The two most frequent ultrasound diagnoses were endometriomas (33.3%), and a simple cyst (30.7%), another diagnoses were paraovarian cyst, mature cystic teratoma, paratubal cyst and complex adnexal mass. Ninety four percent of the masses were unilateral, only 6% were bilateral. Cistectomy was performed in 74.8% of the patients, an ooforectomy in 22.4%, and a salpingectomy in 15.5%. Blood loss (media ± SD) was 106.6 ± 140 mL, with a surgical time of 97.3 ± 48.1 minutes. One patient was complicated by a laceration on the small bowel, and another in the rectum. Two more patients had a hemorrhagic event. All surgical procedures were performed by minimally invasive surgery. We do not found any case of ovarian cancer.
Conclusions: A standardized diagnostic protocol and a multidisciplinary approach can allow us to select the patients with an adnexal mass that are candidates to a management by minimally invasive surgery.

REFERENCES

1. Yamamoto Y, Tsuchida A, Ushiwaka T, Nagai R, Matsumoto M, Komatsu J, Kinoshita H, Minami S, Hayashi A. Comparison of 4 risk-of-malignancy indexes in the preoperative evaluation of patients with pelvic masses: a prospective study. Clinical Ovarian and Other Gynecologic Cancer. 2014; 7(1/2): 8-12.

2. Demir RH, Marchand GJ. Adnexal masses suspected to be benign treated with laparoscopy. JSLS. 2012; 16: 71-84.

3. Kurian AW, Balise RR, McGuire V, Whittemore AS. Histologic Types of epithelial ovarian cancer: have they different risk factors?. Gynecol Oncol. 2005; 96: 520-30.

4. Catalan A, Laiz D, Corvalan J, Masoli D, Vazquez W. Manejo laparoscópico de masa anexiales. Experiencia local. Rev Chil Obstet Ginecol. 2005; 70(4): 231-35.

5. Rueda-Beltz C, Casas A, Ruiz-Sternberg AM. Manejo de masas anexiales benignas por laparoscopia: Experiencia en la unidad de endoscopia ginecológica del Hospital Infantil Universitario Lorencita Villegas de Santos (1995-1999). Rev Colomb Obstet Ginecol. 2001; 51(1): 87-97.

6. Timmerman D, Van Calster B, Testa AC, Guerrieros S, Fischerova D, Lissoni AA, Van Holsbeke C, Fruscio R, Czekierdowski A, Jurkovics D, Savelli L, Vergote I, Bourne T, Van Huffel S, Valentin L. Ovarian cancer prediction in adnexal masses using ultrasound-based logistic regression models: a temporal and external validation study by the IOTA group. Ultrasound Obstet Gynecol. 2010; 36: 226-34.

7. Timmerman D, Ameye L, Fischerova D, Epstein E, Melis GB, Guerriero S, Van Holsbeke C, Savelli L, Fruscio R, Lissoni AA, Testa AC, Veldman J, Vergote I, Van Huffel S, Bourne T, Valentin L. Simple ultrasound rules to distinguish between benign and malignant masses before surgery: prospective validation by IOTA group. BMJ. 2010; 341:c6839.

8. Meys EMJ, Jeelof LS, Achten NMJ, Slangen BFM, Lambrects S, Fruitwagen RFPM, Van-Gorp T. Estimating the risk of malignancy in adnexal masses: an external validation of the ADNEX model and comparison with other frequently used ultrasound methods. Ultrasound Obstet Gynecol. 2016; doi: 10.1002/uog.17225.

9. Gad MS, El Khouly NI, Soto E, Brodman M, Chuang L, Nezhat FR, Gretz HF. Differences in perioperative outcomes after laparoscopic management of benign and malignant adnexal masses. J Gynecol Oncol. 2011; 22(1): 118-24.

10. Rogers EM, Casadiego-Cubides G, Lacy J, Gerstle JT, Kives S, Allen L. Preoperative risk stratification of adnexal masses: can we predict the optimal surgical management. J Pediatr Adolesc Gynecol 2014; 25: 125-8.

11. Carley ME, Klingele CJ, Gebhart JB, Webb Mj, Wilson TO. Laparoscopy versus laparotomy in the management of benign unilateral adnexal masses. J Am Assoc Gynecol Laparosc 2002; 9(3): 321-6.

12. Fanfani F, Fagoti A, Ercoli A, Bifulco G, Longo R, Mancuso S, Scambia G. A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses. Hum Reprod. 2004; 19(10): 2367-71.

13. Covens AL, Dodge JE, Lacchetti C, Elit LM, Le T, Devries- Aboud M, Fung-Kee-Fung M. Surgical management of a suspicious adnexal mass: A systematic review. Ginecol Oncol. 2012; 126: 149-56.

14. La Vecchia C. Ovarian cancer: epidemiology and risk factors. Eur J Cancer Prev. 2015; 00: 000-000.

15. Arteaga-Gomez AC, Aranda-Flores C, Marquez-Acosta G, Colin-Valenzuela A. Tumor anexial y embarazo: diagnóstico y tratamiento. Ginecol Obstet Mex. 2010; 78(3): 160-7.

16. Management of adnexal masses. ACOG Practice Bulletin No.83. American College of Obstetrician and Gynecologist. Obstet Gynecol 2007; 110: 201-14.

17. Scribner DR, Lara-Torre E, Weiss PM. Single-Site laparoscopic management of large adnexal mass. JSLS. 2013; 17: 350-53.

18. Scheib SA, Jones HH, Boruta DM, Simpson K, Bedaiwy M, Grumbine FC, Fader AN. J Minim Invasive Gynecol. 2013; 20: 701-7.

19. Johnson JR, Lee C, Carnett S, Vadakekut E. Laparoscopic management of enlarged serous cystadenoma in advanced pregnancy. J Minim Invasive Gynecol. 2007; 14: 247-9.

20. Havrilesky LJ, Peterson BL, Dryden DK, Soper JT, Clarke- Pearson DL, Berchuck A. Predictors of clinical outcomes in the laparoscopic management of adnexal masses. Obstet Gynecol. 2003; 102:243-51.