Uterine involvement in advanced epithelial ovarian cancer

Background: With an increasing trend for sparing fertility in gynecologic malignancies, we tried to assess uterine involvement in all stages of epithelial ovarian cancer (EOC) in an evidence-based study. Method and Material: From September 1999 to September 2005, 177 patients with epithelial ovarian cancer underwent staging laparatomy in the Gynecologic Oncology Department, Vali Asr University Hospital, Tehran, Iran. Staging data from patient files and pathologic reports were analyzed. Result: Of the 177 cases with EOC, 26% of patients were in Stage I, 13.6% Stage II, 53.1% Stage III and 7.3% Stage IV. Uterine Involvement was 17.9%with serosal involvement in 25 cases (78.1%) and myometrial involvement in seven cases (21.9%). Of these cases 84.4% were in Stages III or more and all had omental involvement (Stage IIIa 7.4%, Stage IIIb 14.8%, Stage IIIc 63% and Stage IV 14.8%). Only 15.6% cases of normal appearing omentum had uterine tumoral involvement. Conclusion: Only eight cases had myometrial involvement out of 177 cases of EOC (all in Stage III). All the eight patients had omental or gross pelvic tumoral involvement. In this study we found that in the absence of gross pelvic or omental involvement in EOC, there is really none or minimal chance of myometrial involvement. Future multicenter studies with more cases will show whether standard hysterectomy by multiple serosal biopsies could be replaced.

Epithelial ovarian cancer; Conservative surgery; Uterine involvement; Omental cake.

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