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. 2021 Oct 14:7:6-11.
doi: 10.1016/j.sopen.2021.09.002. eCollection 2022 Jan.

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

P Laven  1 , J J Beltman  2 , J E Bense  2 , M A van der Aa  3 , T Van Gorp  1   4 , M C Vos  5 , D Boll  6 , Hgj Arts  7 , N Reesink  8 , J B Trimbos  2 , Rfpm Kruitwagen  1
Affiliations

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

P Laven et al. Surg Open Sci. .

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.

Keywords: Lymph nodes; Ovarian cancer; Staging; Surgical oncology.

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Figures

Fig. 1
Fig. 1
Flowchart inclusion.
Fig. 2
Fig. 2
Reasons for incomplete staging. Per staging element reasons for omitting the particular element of the staging procedure are described and counted.
See this image and copyright information in PMC

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