ObjectiveTo test the hypothesis that laparoscopic management of ovarian tumors did not decrease patient safety when those tumors were subsequently diagnosed as malignant.Material and MethodsA questionnaire was sent to 273 German departments of obstetrics and gynecology concerning the type of primary laparoscopic techniques used; the secondary cancer operation; cytotoxic treatment; time interval between laparoscopy and cancer operation; and follow-up in cases of ovarian cancer, dysgerrninoma, malignant teratoma, tubal cancer and borderline tumor of the ovary. A responses rate of 46% was obtained from 127 hospitals.ResultsIn the survey, the 192 ovarian malignancy cases managed laparoscopically seem to be an underestimate of the expected frequency in Germany. In the vast majority of these cases, laparoscopic techniques (capsule rupture, biopsy, tumor morcellation) were used that must be considered to be in violation of oncologic guidelines. For example, intact removal of the tumor using an endobag was implemented in only 6 of 81 (7.4%) cases of stage la ovarian cancer. The impact of the laparoscopic techniques used can be seen in the early follow-up of patients on whom secondary cancer surgery was performed 8 days later. Because of this delay, it could be seen that the spilling of tumor cells had already developed to implantations and metastases were macroscopically visible. In 50% (5/10) of cases of stage la borderline rumors and in 73% (26/36) of cases of stage la ovarian cancer, an early progression to stage Ic-III was noted; and in 53% of cases of stage la ovarian cancer (19/36), progression to stage II and III was observed. In 50 cases of laparoscopically managed stage Ic-III ovarian cancer, an early tumor spread to the laparoscopic trocar tract was evident in 52% (13/25) of patients when subsequent radical surgery was delayed more than 8 days. Patients who underwent adequate cancer surgery immediately or within 6 days of the laparoscopic management of ovarian malignancies showed no macroscopically visible signs of progression (metastases, implantations). Such “negative” findings in the German survey do not exclude later findings of iatrogenic progression.ConclusionAccurate preoperative definition of the existence of ovarian tumors is not possible. To thoroughly consider the safety of patients, every ovarian tumor should be considered