Surgical Management of an Adnexal Mass Suspicious for Malignancy

Objective: to outline the preoperative, intraoperative, and postoperative management of patients who present with a pelvic mass suspicious for malignancy. Options: these guidelines discuss the surgical procedures involved in the adequate staging and debulking of the adnexal mass, the role of the gynaecologist and gynaecologic oncologist, and the timing of surgery in relation to the use of chemotherapy. Outcomes: survival is the outcome of interest. Evidence: a literature search was conducted using Medline, CancerLit, and Embase from 1960, using the terms “ovarian neoplasm,” “surgery,” “guidelines,” “consensus,” “statement.” Values: the evidence collected was reviewed by the Society of Obstetricians and Gynaecologists of Canada (SOGC)/ Gynaecologic Oncologists of Canada (GOC)/Society of Canadian Colposcopists (SCC) Policy and Practice Guidelines Committee members under the leadership of the primary author and quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on the Periodic Health Exam. Benefits, harms, and costs: benefits are described in terms of three or five year survival. Harm is implied by the decreased survival benefit when suboptimal surgery is performed. Recommendations: 1. Women with disease confined to the ovary should receive thorough surgical staging to provide the woman with maximum information to inform her decision for or against adjuvant therapy. The more localized the disease appears, the more extensive the assessment should be, including the biopsies required to confirm the clinical impression of low stage disease. (II-3 A) 2. At the initial surgery, patients with extensive abdominal disease should have an attempt at optimal debulking. (II-3 B) 3. Women with liver metastases or obvious para-aortic lymphadenopathy should be referred to a gynaecologic or medical oncologist prior to embarking on surgery to rule out a gastrointestinal primary and to allow consideration of neoadjuvant therapy. (III B) Validation: these guidelines were reviewed and approved by the SOGC/GOC/SCC Policy and Practice Guidelines Committee. S O G C C L I N I C A L P R A C T I C E G U I D E L I N E S Surgical Management of an Adnexal Mass Suspicious for Malignancy These clinical practice guidelines have been reviewed and approved by the SOGC/GOC/SCC Policy and Practice Guidelines Committee of the Society of Obstetricians and Gynaecologists of Canada. No. 97, November 2000 These guidelines reflect emerging clinical and scientific advances as of the date issued and are subject to change.The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions.They should be well documented if modified at the local level. None of the contents may be reproduced in any form without prior written permission of SOGC. PRINCIPAL AUTHOR Laurie Elit MD, MSc, FRCSC, Hamilton, ON SOGC/GOC/SCC POLICY AND PRACTICE GUIDELINES COMMITTEE MEMBERS Marie Plante, (Chair), MD, FRCSC, Quebec City, QC Paul Bessette, MD, FRCSC, Sherbrooke, QC A. Denny DePetrillo, MD, FRCSC, Toronto, ON Thomas Ehlen, MD, FRCSC,Vancouver, AB Mark Heywood, MD, FRCSC, Winnipeg, MB Lynne Jolicoeur, RN, Ottawa, ON Barry Rosen, MD, FRCSC, Toronto, ON Gavin C.E. Stuart, MD, FRCSC, Calgary, AB