COMPARISON BETWEEN LAPAROSCOPY AND LAPAROTOMY IN THE SURGICAL RE- STAGING OF GRANULOSA CELL TUMORS OF THE OVARY
M.Peiretti, E.Ricciardi, S.Bruni, A.Proto*, G. Aletti, G. Candotti, N. Colombo, V.Zanagnolo, and A.Maggioni

To evaluate the role of laparoscopic (LPS) and laparotomic (LPT) staging in patients with incompletely surgically staged ovarian granulosa cell tumors (OGCT).

All medical records of  patients with OGCT that were managed as inpatients from March 1994 to March 2017 at the Division of Gynaecologic Oncology, European Institute of Oncology in Milan, were reviewed. Information about the age at time of diagnosis, FIGO stage, histology, grade, treatment and survival, were extracted. The initial date of diagnosis ranged from 1990 to 2017.

We found from our database a total of 170 patients with a median age of 49 years (range, 15-84 years); 145 (85%) patients had adult type and 13 (7,6%) had juvenile granulosa cell tumors, 10 (5,8%) had Sertoli-Leydig tumour, 1 patient (0,5%) had a Sex-cord tumour with annular tubules and 1 had Steroid cell tumour. Eighty-four patients (49,5%) received primary surgery  that included a hysterectomy; 86 patients (50,5%) underwent fertility-sparing surgery 
Eighty-one patients (48%) with diagnosis of OGCT were incompletely surgically staged at another institution. We completed the surgical staging with peritoneal assessment, infracolonic omentectomy and abdominal/pelvic washings after a mean delay time from the diagnosis of 3.5 months (range 1-8 months). We evaluated our results in terms of laparoscopic treatment (56 patients) and laparotomic treatment (25 patients). The original clinical International Federation of Gynecology and Obstetrics (FIGO) stage of the LPS-group was IA in 35 patients, IB in 1, IC in 18 and IIC in 2. After  surgical restaging  performed by LPS, 10/56 (19%) were upstaged. Among the IA  patient’s group, 1 was upstaged to IB stage and  3 to IIB (4/35); among patients with  stage IC, 1 was upstaged to IIA, 4 to IIB   and 1 to IIIC stage (6/18). 
In the LPT-group the FIGO stage was IA in 11 patients, IC in 11, IIIA in 1, IIIB in 1 and IIIC in 1 patient. After second surgery performed by LPT, 7/25 (28%) were upstaged. Among the IA patient’s group, 1 was  upstaged to IIB stage and  2 to IIIB (3/11);  among patients with  IC stage, 1 was upstaged to IIA, 2 to IIB  and 1 to IIIB stage (4/11). 
There were no major intraoperative or postoperative complications. Adjuvant chemotherapy was given to the upstaged (IIB-IIIC) patients. 

According to our series, laparoscopic restaging compared to the open approach seems to be a feasible and efficient technique to complete surgical staging in  patients with GCTs incorrectly staged.
Surgical restaging seems to upstage a considerable number of OGCT, mainly in the initial stage IC group of patients. However,  the impact of restaging on final outcome and survival remains to be demonstrated.