Clinical outcome and survival analysis in ovarian cancer associated with endometriosis

Objective: Intra-abdominal carcinomatosis can be from either gynecologic or other origins.It is important to confirm histopathology and the extent of disease involvement before initiating treatment.Methods: Nine consecutive patients (4 consulted by gastrointestinal specialists, 2 consulted by hematologic oncologists, and 3 referred from other hospitals) receiving singleport laparoscopic assessment for carcinomatosis of uncertain origin during January 2015 and August 2017 were included in the current series.Results: Among the 9 patients, final diagnosis included primary peritoneal serous carcinoma (n=5), gastric cancer (n=2), ovarian serous carcinoma (n=1) and cholangiocarcinoma (n=1).Surgical specimen was sent for frozen section in 7 patients, but conclusive diagnosis was not available in four intraoperatively.Laparoscopic procedures included abdomino-pelvic inspection (n=8), ascites drainage and cytology (n=8), omental biopsy (n=7), peritoneal biopsy (n=4), salpingo-oophorectomy (n=2) and ovarian biopsy (n=1), and the mean blood loos was 73 mL .Conversion to laparotomy occurred in one patient due to technical limitation.The other 8 patients resumed diet within 1 day postoperatively.One patient underwent extracorporeal repair of bowel seromuscular tear via transumbilical incision followed by other single-port laparoscopic procedures.The median time from laparoscopic assessment to definitive surgery (n=2) or chemotherapy (n=3) were 9 days (3-16).Conclusion: Single-port laparoscopic assessment via transumbilical open entry is feasible and effective for the pretreatment evaluation of carcinomatosis of uncertain origin.It might be safer to enter the peritoneal cavity by this open method than by blind penetration, especially for these patients with carcinomatosis who had potential risk of bowel adhesion to parietal abdominal wall.Through the 2-cm transumbilcal incision, larger specimen can be removed more easily than through traditional 5-12 mm ports.Extracorporeal surgical procedures via transumbilical incision can also be applied when indicated.The theoretical risk of port-site metastasis might also be reduced.The patients recovered well, and subsequent treatment can be initiated soon.