多学科实施侵袭性术式在复发性卵巢癌二次肿瘤细胞减灭术中的意义

Value of multi-disciplinary cooperating in second cytoredutive surgery for recurrent epithelial carcinoma

目的探讨复发性卵巢上皮癌二次肿瘤细胞减灭术中实施侵袭性术式的必要性及多学科手术团队参与的意义。方法收集郑州大学附属肿瘤医院妇瘤科接受二次肿瘤细胞减灭术复发性卵巢上皮癌患者的临床及手术资料,共62例,依据手术团队学科组成分为两组:妇瘤科手术组18例,妇瘤科与胃肠、肝胆外科医师多学科手术组44例。依据术中发现,评估清除所有病灶时所需侵袭性手术例次;比较2组实际侵袭性术式实施例数、减瘤结局及手术并发症。结果依术中发现评估,7例(11.3%)无需侵袭性手术、47例(75.8%)需要83例次侵袭性手术方式可达到肉眼无瘤。两组围手术期均无死亡病例。结论复发性卵巢癌二次肿瘤细胞减灭术以肉眼无瘤为减瘤目标,多需实施上腹部脏器及结直肠切除的侵袭性手术方式,多学科共同施术是获得理想手术结局的保证。

Objective To investigate the value of multi- disciplinary approach in second cytoredutive surgery for recurrent epithelial carcinoma. Methods The retrospective study included 62 patients with recurrent ovarian epithelial carcinoma who received second cytoreductive surgery. According to different surgical team,all patients were devided into two groups. 44 patients received surgeries with gynecological oncologists and general surgeons or hepatobilliary surgeons as multi- disciplinary group; 18 patients received surgeries with gynecological oncologists only as gynecological group.Based on surgical exploration,necessary aggressive surgical procedures during second cytoreduction in each patient for removal all gross recurrent diseases were estimated. Actural surgical procedures and surgical outcomes in all patient during second cytoredutive surgery were analyzed in detail. Results It was estimated that 47（ 75. 8%） patients need 83 times of aggressive surgical procedures to remove all gross diseases,only 7（ 11. 3%） patients can achieve no residual diseases without aggressive surgical procedures. Conclusion Aggressive surgery may be always necessary to removal all diseases in second cytoreductive surgery for recurrent epithelial ovarian cancer. Multi- discioplinary surgical team is more suitable to carry it out successfully than gynecological oncologists alone.