晚期卵巢癌、输卵管癌及原发性腹膜癌腹腔镜肿瘤细胞减灭术的安全性及有效性研究

The Safety and Efficacy of Laparoscopic Surgical Staging and Debulking of Apparent Advanced Stage Ovarian,Fallopian Tube,and Primary Peritoneal Cancers

目的总结晚期卵巢癌、输卵管癌和腹膜癌患者行腹腔镜初次或间歇性肿瘤细胞减灭术的临床经验。方法回顾分析接受腹腔镜肿瘤细胞减灭术的晚期卵巢癌(FIGOⅡc期以上)、输卵管癌和原发性腹膜癌患者临床资料。结果 32名患者接受腹腔镜评估手术。17例接受全腹腔镜肿瘤细胞减灭术,其中88.2%为满意的肿瘤细胞减灭术;11例腹腔镜评估后转开腹肿瘤细胞减灭术,其中72.7%为满意的肿瘤细胞减灭术;4例仅进行活检和(或)姑息手术。腹腔镜组平均随访时间19.7月9,例无瘤生存6,例带瘤生存2,例因肿瘤死亡。开腹组平均随访时间25.8月,3例无瘤生存,5例带瘤生存,3例因肿瘤死亡。腹腔镜组术中失血量较少,术后住院时间较短(P=0.008和P=0.03),但手术时间及并发症发生率与开腹组相比无统计学差异。中位复发时间,腹腔镜组为31.7月,开腹组为21.5个月(P=0.3)。结论对于经过精心挑选的晚期卵巢癌、输卵管癌和原发性腹膜癌病例,采用腹腔镜进行诊断、分期和肿瘤细胞减灭术,在技术上是可行的。

Objectives To describe our experience with laparoscopic primary or interval tumor debulking in patients with presumed advanced ovarian, fallopian tube, or peritoneal cancers. Methods This is a retrospective analysis of a prospective case series. Women with presumed advanced （FIGO stage IIC or greater） ovarian, fallopian tube, or primary peritoneal cancers deemed appropriate candidates for laparoscopic debulking by the primary surgeon （s） were recruited. Results The study comprised 32 patients who underwent laparoscopic evaluation. Seventeen underwent total laparoscoplc primary or interval cytoreduetion, with 88.2% optimal cytoreduetion. Eleven underwent diagnostic laparoscopy and conversion to laparotomy for cytoreduction, with 72. 7% optimal cytoreduction. Four patients had biopsies, limited cytoreduction, or both. In the laparoscopy group, 9 patients have no evidence of disease （NED）, 6 are alive with disease （AWD）, and 2 have died of disease （DOD）, with mean follow-up time of 19.7 months. In the laparotomy group, 3 patients are NED, 5 are AWD, and 3 are DOD, with mean follow-up of 25.8 months. Estimated blood loss and length of hospital stay were less for the laparoscopy group （ P = 0. 008 and P = 0.03 ） , while operating time and complication rates were not different. Median time to recurrence was 31.7 months for the laparoseopy group and 21.5 months for the laparotomy group （P = 0.3）. Conclusions Laparoscopy can be used for diagnosis, triage, and debulkingof patients with advanced ovarian, fallopian tube, or primary peritoneal cancer and is technically feasible in a well-selected population.