Mulheres com diagnóstico de tumores ovarianos de baixo potencial de malignidade têm um excelente prognóstico. Pelo fato de poucas pacientes receberem terapia adjuvante, o benefício do estadiamento cirúrgico tem sido recentemente um desafio. Em um artigo publicado na Obstetrics & Gynecology, os autores compararam o resultado do estadiamento cirúrgico de pacientes com tumores de baixo potencial malignidade com aquelas que não foram estadiadas.
Entre 1984 e 2003, todas as mulheres com tumores de ovário de baixo potencial de malignidade foram identificadas em três instituições. Os dados foram extraídos dos prontuários médicos. Centro e oitenta e três (74%) das 248 mulheres foram estadiadas cirurgicamente. Quarenta das 183 pacientes estadiadas apresentaram clinicamente doença extra-ovariana evidente. Os lavados citológicos foram positivos em 28 casos, 10 apresentaram implantes microscópicos detectados por biópsia peritoneal ou omental e duas mudaram para o estágio IIIC apenas com base nas metástases linfonodais.
Cento e oitenta mulheres foram submetidas à dissecção linfonodal pélvica (média: 5 linfonodos) e 86 foram submetidas à dissecção dos linfonodos para-aórticos (média: 2 linfonodos). No geral, 9 (1%) metástases foram detectadas em 832 linfonodos pélvicos ressecados. Todos os 314 linfonodos para-aórticos foram negativos.
A perda sanguínea intra-operatória (P < .001) e o tempo de internação hospitalar (P < .001) aumentaram nas mulheres sem doença consumada que foram cirurgicamente estadiadas. Oito (3%) das 248 pacientes receberam quimioterapia adjuvante, porém nenhuma das mulheres que passaram para o estádio IIIC com base nos resultados da dissecção linfonodal receberam tratamento. Quinze (6%) recidivas ocorreram e uma (0.4%) morte ocorreu após um seguimento médio de 28 (variação, 1-208) meses.
De acordo com os autores, a rotina da dissecção linfonodal pélvica e para-aórtica não é necessária na maioria das mulheres com tumores ovarianos de baixo potencial de malignidade.
Surgical Staging of Ovarian Low Malignant Potential Tumors - Obstetrics & Gynecology - 2004;104:261-266
Surgical Staging of Ovarian Low Malignant Potential Tumors
Gautam G. Rao, MD*, Elizabeth Skinner, MD
, Paola A. Gehrig, MD, Linda R. Duska, MD
, Robert L. Coleman, MD* and John O. Schorge, MD*
From the *Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill Medical School, Chapel Hill, North Carolina; and Department of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital, Boston, Massachusetts.
Address reprint requests to: John O. Schorge, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, J7.124, Dallas, TX; e-mail: john.schorge@utsouthwestern.edu.
OBJECTIVE: Women diagnosed with ovarian tumors of low malignant potential have an excellent prognosis. Because few will receive adjuvant therapy, the benefit of surgical staging has recently been challenged. The purpose of this study was to compare the outcome of surgically staged patients with low malignant potential tumors with those who were not staged.
METHODS: Between 1984 and 2003, all women with ovarian low malignant potential tumors were identified at 3 institutions. Data were extracted from clinical records.
RESULTS: One hundred eighty-three (74%) of 248 women were surgically staged. Forty of 183 staged patients had clinically obvious extraovarian disease. Forty (28%) of the remaining 143 women with disease apparently confined to the ovary were upstaged. Cytologic washings were positive in 28 cases, 10 had microscopic implants detected by peritoneal or omental biopsy, and 2 were upstaged to stage IIIC solely on the basis of nodal metastases. One hundred eighteen women underwent pelvic node dissection (median: 5 nodes), and 86 underwent para-aortic node dissection (median: 2 nodes). Overall, 9 (1%) metastases were detected in 832 submitted pelvic nodes. All 314 para-aortic nodes were negative. Intraoperative blood loss (P < .001) and length of hospital stay (P < .001) were increased in women without gross disease who were surgically staged. Eight (3%) of 248 patients received adjuvant platinum-based chemotherapy, but neither of the women upstaged to IIIC based on the results of their nodal dissection were treated. Fifteen (6%) recurrences developed and 1 (0.4%) death occurred after a median follow-up of 28 (range, 1–208) months.
CONCLUSION: Routine pelvic and para-aortic lymph node dissection is not necessary in the majority of women with ovarian low malignant potential tumors.
LEVEL OF EVIDENCE: III
