ORIGINAL ARTICLE Surgical treatment of large adnexal masses: a retrospective analysis of 330 consecutive cases Jvan Casarin a,b , Antonio Simone Lagan a a , Stefano Uccella c , Antonella Cromi a , Ciro Pinelli a , Baldo Gisone a , Camilla Borghi a , Selene Cominotti a , Simone Garzon a , Matteo Morotti b , Roberto Tozzi b and Fabio Ghezzi a a Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy; b Gynecologic Oncology Unit, Oxford University Hospitals, NHS Trust, Oxford, UK; c Department of Woman and Child Health, Fondazione Policlinico Agostino Gemelli, I.R.C.C.S. Rome, Italy ABSTRACT Introduction: In the present study, perioperative outcomes of laparoscopy (LPS) were compared to open surgery (OS) for the treatment of large adnexal masses (AM). Material and methods: Retrospective observational cohort study. Data of consecutive patients who underwent ovarian cystectomy or salpingo-oophorectomy for large AM (diameter 10 cm) at a referral minimally invasive gynecologic center were analyzed. Propensity score match (PSM) analysis was used to minimize covariate imbalances between the two groups. Results: Overall 330 patients, 285 (86.4%) LPSs and 45 (13.6%) OSs were included. PSM showed LPS (vs. OS) to be associated with less intraoperative blood loss (mL: 131.1 ± 52.6 vs. 545.5 ± 101.2; p ¼ .007), shorter operative time (min: 84.8 ± 77.9 vs. 123.7 ± 70.1; p < .001), but higher rate of spillage (54.5% vs. 12.1%; p < .001). Among the LPS group, a positive correlation between AM size and both conversion to open surgery and need for mini-laparotomy was found (p < .05). Conclusions: An accurate patient selection, a dedicated workup, and an appropriate counselling are mandatory before LPS for large AM. The increased risks of intraoperative spillage associated with the minimally invasive approach should be acknowledged. ARTICLE HISTORY Received 21 March 2019 Accepted 24 June 2019 KEYWORDS laparoscopy; open surgery; adnexal mass; ovarian cyst; spillage Introduction It is estimated that approximately 10% of women will undergo surgery for adnexal masses (AM) during their life [1]. About 80% of AM are seen in women younger than fifty-five years, and the large majority of them have benign histology confirmed at final pathology. Ovarian cancer represents only the 0.4% of all AM (approximately 10% of the surgically treated ones) [2,3], and its incidence increases with age [4]. Different types of management can be offered to women with AM, and the risks and benefits of a con- servative approach (with clinical follow-up over time) versus a surgical treatment (ovarian cystectomy or sal- pingo-oophorectomy) should be accurately discussed with the patient [5]. In cases of large AM, surgery might be required because of the presence of symp- toms, risk of adnexal torsion [6] or suspicion of malignancy [7]. The well-known advantages associated with the minimally invasive approach, when compared with open surgery (OS), apply not only for the treatment of uterine benign and malignant diseases [8–10] but also for the surgical management of AM. As such, several studies have demonstrated perioperative bene- fits of LPS over OS in terms of reduction of postoper- ative pain, reduced perioperative morbidity, shorter length of hospitalization, and less surgical-related costs [11]. Although several retrospective studies reported successful surgical outcomes related to the minimally invasive management of large AM [12–18], it is a prevailing opinion that the feasibility and onco- logic safety of LPS decreases together with the increase of the AM size. This might have an impact on the a priori decision of performing surgery through a minimally invasive approach in cases of large AM. In the present investigation, we aimed to evaluate the risk of spillage and the perioperative outcomes of women who underwent surgery for large AM with diameters 10 cm. In addition, a systematic review of CONTACT Simone Garzon simone.garzon@yahoo.it Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Piazza Biroldi 1, 21100, Varese, Italy ß 2019 Society of Medical Innovation and Technology MINIMALLY INVASIVE THERAPY & ALLIED TECHNOLOGIES https://doi.org/10.1080/13645706.2019.1649700