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Objective <p>To evaluate the impact of surgical approach, completeness of staging, and intraoperative tumor rupture on recurrence patterns and survival outcomes in granulosa cell tumors (GCT) of the ovary.</p> Methods <p>A retrospective study was conducted at a tertiary referral center between 2009 and 2022. Forty-three patients with histologically confirmed GCT who underwent either fertility-sparing or definitive surgery via open or minimally invasive approach were included. Surgical details, clinico-pathological features, adjuvant therapy, and recurrence data were analyzed. Survival outcomes were assessed using Kaplan–Meier analysis, and statistical significance was set at <i>p</i> &lt; 0.05.</p> Results <p>The majority of patients (90%) had Stage I disease; 76% underwent open surgery and 24% laparoscopic&#xa0;surgery. Complete surgical staging was performed in 30%, and fertility-sparing surgery in 21%. Intraoperative tumor rupture occurred exclusively in laparoscopic procedures (14%) and was associated with significantly poorer OS (94 vs. 246&#xa0;months, <i>p</i> = 0.015) and RFS (42 vs. 158&#xa0;months, <i>p</i> &lt; 0.001). Recurrence was significantly higher following minimally invasive surgery (66.7% vs. 25.8%, <i>p</i> = 0.031). Fertility-sparing and incomplete surgeries did not show statistically significant differences in survival outcomes.</p> Conclusion <p>Minimally invasive surgery and intraoperative rupture were significantly associated with worse survival outcomes in GCT. These findings underscore the importance of careful surgical planning, particularly in choosing surgical approach and avoiding rupture, to improve long-term outcomes. Surgical completeness and fertility preservation did not adversely affect survival, supporting individualized surgical decision-making in GCT management.</p>

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Surgical Strategy and Recurrence Risk in Granulosa Cell Tumors: The Long-Term Impact of Intraoperative Factors

  • 期刊论文

  • 发表日期：

    2025年10月12日

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  • Neeta Subbegowda,
  • Divya Panyam Vuppu,
  • Priya Bhati

摘要

Objective

To evaluate the impact of surgical approach, completeness of staging, and intraoperative tumor rupture on recurrence patterns and survival outcomes in granulosa cell tumors (GCT) of the ovary.

Methods

A retrospective study was conducted at a tertiary referral center between 2009 and 2022. Forty-three patients with histologically confirmed GCT who underwent either fertility-sparing or definitive surgery via open or minimally invasive approach were included. Surgical details, clinico-pathological features, adjuvant therapy, and recurrence data were analyzed. Survival outcomes were assessed using Kaplan–Meier analysis, and statistical significance was set at p < 0.05.

Results

The majority of patients (90%) had Stage I disease; 76% underwent open surgery and 24% laparoscopic surgery. Complete surgical staging was performed in 30%, and fertility-sparing surgery in 21%. Intraoperative tumor rupture occurred exclusively in laparoscopic procedures (14%) and was associated with significantly poorer OS (94 vs. 246 months, p = 0.015) and RFS (42 vs. 158 months, p < 0.001). Recurrence was significantly higher following minimally invasive surgery (66.7% vs. 25.8%, p = 0.031). Fertility-sparing and incomplete surgeries did not show statistically significant differences in survival outcomes.

Conclusion

Minimally invasive surgery and intraoperative rupture were significantly associated with worse survival outcomes in GCT. These findings underscore the importance of careful surgical planning, particularly in choosing surgical approach and avoiding rupture, to improve long-term outcomes. Surgical completeness and fertility preservation did not adversely affect survival, supporting individualized surgical decision-making in GCT management.