Oophorectomy for Benign and Malignant Conditions

Introduction

The ovary is a complex organ from both a histologic and a functional standpoint. As a result, numerous tumors, benign and malignant, can arise in the adnexa. The surgical approach is often determined by the pathology as well as the desire to preserve gonadal function and fertility.

Although the majority of tumors arising in the ovary are benign, especially in younger women, proper surgical management of ovarian or tubal malignancy is much more complex. Epithelial ovarian and tubal malignancies tend to metastasize early and spread along peritoneal surfaces throughout the abdomen. These surgeries are designed to render the patient with minimal residual disease and often require pelvic peritonectomy with en bloc rectosigmoid resection to clear the pelvis. Complete cytoreductive surgery often includes equally radical upper abdominal resection. Multiple studies have shown that complete cytoreduction of metastatic disease affects overall survival rates and progression-free survival rates in women with epithelial ovarian malignancy. Overall survival rates of 66 to 120 months is achievable, even in women with advanced disease.

Preoperative Imaging

Preoperative imaging of an adnexal mass helps not only to characterize the tumor but also to assess for ascites, hydronephrosis, lymphadenopathy, and omental implants that may affect the preoperative counseling and surgical approach. Ultrasonography is the most frequently used modality to assess a pelvic mass. It is readily accessible, noninvasive, and provides excellent delineation of ovarian tumors. The ultrasonographer should comment on lesion size, cystic/solid components, complexity, and Doppler flow along with evidence of hydronephrosis and ascites. Although magnetic resonance imaging (MRI) can provide significantly more information about an ovarian tumor, in reality MRI is rarely helpful in triaging an adnexal mass. Advanced imaging may help determine the extent of the lesion and provide useful information in planning complex surgical resections. Most lesions believed to be complex should be removed in all age groups. Computed tomography (CT) scans are essential to evaluate the retroperitoneum and upper abdomen in women with an ovarian mass that may be malignant.