Partie 1 rédigée sur la base de la recommandation nationale de bonnes pratiques cliniques en cancérologie intitulée « Conduites à tenir initiales devant des patientes atteintes d’un cancer épithélial de l’ovaire » élaborée par FRANCOGYN, CNGOF, SFOG, GINECO-ARCAGY et labélisée par l’INCa. (Explorations diagnostiques et bilan d’extension, chirurgie, soins périopératoires et anatomopathologie)

• Published in: Gynécologie, obstétrique, fertilité & sénologie obstétrique, fertilité & sénologie, 2019-02, Vol.47 (2), p.100-110
• Main Authors: Lavoué, V, Huchon, C, Akladios, C, Alfonsi, P, Bakrin, N, Ballester, M, Bendifallah, S, Bolze, P A, Bonnet, F, Bourgin, C, Chabbert-Buffet, N, Collinet, P, Courbiere, B, de La Motte Rouge, T, Devouassoux-Shisheboran, M, Falandry, C, Ferron, G, Fournier, L, Gladieff, L, Golfier, F, Gouy, S, Guyon, F, Lambaudie, E, Leary, A, Lécuru, F, Lefrère-Belda, M A, Leblanc, E, Lemoine, A, Narducci, F, Ouldamer, Lobna, Pautier, P, Planchamp, F, Pouget, N, Ray-Coquard, I, Rousset-Jablonski, C, Sénéchal-Davin, C, Touboul, C, Thomassin-Naggara, I, Uzan, C, You, B, Daraï, E
• Format: Article
• Language: fre
• Subjects: Cancer; Life Sciences
• ISSN: 2468-7197; 2468-7189
• DOI: 10.1016/j.gofs.2018.12.010

Faced to an undetermined ovarian mass on ultrasound, an MRI is recommended and the ROMA score (combining CA125 and HE4) can be proposed (grade A). In case of suspected early stage ovarian or fallopian tube cancer, omentectomy (at least infracolonic), appendectomy, multiple peritoneal biopsies, peritoneal cytology (grade C) and pelvic and para-aortic lymphadenectomy are recommended (grade B) for all histological types, except for the expansive mucinous subtype where lymphadenectomy may be omitted (grade C). Minimally invasive surgery is recommended for early stage ovarian cancer, if there is no risk of tumor rupture (grade B). Laparoscopic exploration for multiple biopsies (grade A) and to evaluate carcinomatosis score (at least using the Fagotti score) (grade C) are recommended to estimate the possibility of a complete surgery (i.e. no macroscopic residue). Complete medial laparotomy surgery is recommended for advanced cancers (grade B). It is recommended in advanced cancers to perform para-aortic and pelvic lymphadenectomy in case of clinical or radiological suspicion of metastatic lymph node (grade B). In the absence of clinical or radiological lymphadenopathy and in case of complete peritoneal surgery during an initial surgery for advanced cancer, it is possible not to perform a lymphadenectomy because it does not modify the medical treatment and the overall survival (grade B). Primary surgery is recommended when no tumor residue is possible (grade B).