A 45-year-old woman undergoes surgery for a 12 cm right ovarian tumour. Intraoperatively, the tumour appears multiloculated with papillary projections. Frozen section shows serous borderline tumour (low malignant potential). She has completed her family. The most appropriate surgical management is:
- A Right salpingo-oophorectomy only and close follow-up
- B Cytoreductive surgery plus immediate adjuvant platinum chemotherapy
- C Comprehensive surgical staging: bilateral salpingo-oophorectomy, hysterectomy, omentectomy, peritoneal biopsies ✓
- D Right salpingo-oophorectomy followed by 6 cycles of carboplatin-paclitaxel
Correct answer: C. Comprehensive surgical staging: bilateral salpingo-oophorectomy, hysterectomy, omentectomy, peritoneal biopsies
Explanation
For a postmenopausal woman who has completed her family with a serous borderline ovarian tumour, comprehensive surgical staging is recommended: bilateral salpingo-oophorectomy, total hysterectomy, omentectomy, and multiple peritoneal biopsies. This adequately stages the disease and prevents contralateral recurrence. Adjuvant chemotherapy is not indicated for borderline tumours as they do not respond to platinum-based regimens. Conservative surgery (cystectomy/unilateral oophorectomy) is only for women desiring fertility.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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