LAPAROSCOPIC MANAGEMENT OF ADNEXAL MASSES IN WOMEN WITH A HISTORY OF NONGYNECOLOGIC MALIGNANCY

Objective: To describe the safety and efficacy of laparoscopy in the diagnosis and treatment of patients with a history of nongynecologic malignancy presenting with an adnexal mass. Methods: A retrospective review of the records of all patients with a history of nongynecologic malignancy who underwent laparoscopy for adnexal masses at our institution in 1992-1994. Results: Thirty-four patients were identified. The mean age was 57.3 years (range 32-85). Twenty-five had breast cancer, three had malignant melanoma, and two had lymphoma; the remaining four had lung, colon, stomach, and pancreatic cancer, respectively. Thirty of the 34 cases (88%) were managed laparoscopically; unilateral or bilateral salpingo-oophorectomy was performed in 22 laparoscopically assisted vaginal hysterectomy in three, ovarian cystectomy in three, and pelvic washings in two. In these cases, the adnexal disease was benign in 24 and metastatic cancer in six. In all the metastatic cases, preoperative ultrasound or computed tomography scan revealed complex and/or solid adnexal masses. Six complications occurred in the 34 eases; two of 25 patients who had D&C had uterine perforation, two patients had subcutaneous hematomas at laparoscopic puncture sites, one had a bowel obstruction, and one developed pneumonia after laparotomy. Conclusion: Laparoscopy proved to be safe and effective in the initial surgical evaluation of patients with a history of a nongynecologic malignancy presenting with an adnexal mass. Most patients can be spared the added morbidity and convalescence associated with laparotomy. This laparoscopic approach should be considered the initial method of surgical evaluation in this population.