腹腔镜下初始肿瘤细胞减灭术与中间型肿瘤细胞减灭术对晚期卵巢肿瘤的疗效比较

Comparison of the efficacy of laparoscopic primary cytoreductive surgery and interval debulking surgery in the treatment of advanced ovarian cancer

目的 对比分析腹腔镜下初始肿瘤细胞减灭术(PCS)与中间型肿瘤细胞减灭术(IDS)对晚期卵巢肿瘤患者的治疗效果。方法 收集25例接受腹腔镜手术治疗的晚期卵巢癌患者的临床资料,根据临床策略不同分为2组。PCS组12例,接受腹腔镜下PCS;IDS组13例,接受腹腔镜下IDS,对比分析两组的疗效。结果 两组的化疗疗程数、淋巴结切除数、淋巴结切除病例、淋巴结转移病例、手术时间及术中出血量比较差异均无统计学意义(P>0.05)。IDS组发生1例肠道损伤的手术相关并发症。随访期间,PCS组复发6例,IDS组11例。PCS、IDS组患者中位无进展生存期(mRFS)分别为35.75、21.31个月,中位生存时间(mOS)分别为48.33、36.15个月,生存率分别为83.3%、46.2%。结论 利用腹腔镜的准确评估对晚期卵巢癌患者实施PCS或IDS,在技术上是可行的;IDS实施前接受紫杉醇联合卡铂辅助化疗可提高腹腔镜手术的成功率。

Objective To observe the clinical efficacy of laparoscopic primary cytoreductive surgery(PCS) and interval debulking surgery(IDS) in the treatment of advanced ovarian cancer. Methods The clinical data of 25 patients with advanced ovarian cancer who received laparoscopic PCS and IDS were collected. According to different clinical strategies, they were divided into 2 groups: 12 cases in PCS Group(who received laparoscopic PCS) and 13 cases in IDS Group(who received laparoscopic IDS). The efficacy of the two groups was compared and analyzed. Results There were no statistical differences in the number of chemotherapy treatment courses, the number of number, the cases with lymphadenectomy, the cases with lymphatic metastasis, operation duration and intraoperative blood loss between the two group(P>0.05). There was 1 case of operative complication of intestinal injury in IDS Group. During the follow-up, there were 6 relapsed cases in PCS Group and 11 cases in IDS Group. The median progression-free survival(mRFS) of patients in PCS Group and IDS Group were 35.75 and 21.31 months, respectively, and their median overall survival(mOS) was 48.33 months and 36.15 months, respectively. The survival rate of the two groups was 83.3% and 46.2%, respectively. Conclusion It is technically feasible to perform PCS or IDS in patients with advanced ovarian cancer using accurate laparoscopic evaluation. NACT prior to IDS improves the success rate of laparoscopic surgery.