扩大盆腔内侧壁切除术治疗晚期及复发妇科恶性肿瘤的临床病理分析

Laterally extended endopelvic resection for advanced or recurrent gynecological malignancies:clinicopathological analysis

探讨扩大盆腔内侧壁切除术(LEER)治疗累及盆腔侧壁的晚期、复发妇科恶性肿瘤的可行性及安全性,评估该新型挽救性手术的治疗潜力。回顾性分析2019年1月至2021年9月在复旦大学附属妇产科医院接受LEER手术的5例妇科恶性肿瘤患者的临床病理资料,包括3例复发性宫颈癌,1例晚期子宫内膜癌和1例盆腔侵袭性血管黏液瘤(AAM)病例。其中4例患者实现完全切除(R0切除),切缘阴性;1例复发宫颈癌患者因继续手术风险极大而终止手术。中位手术时间为345 min(225~482 min),中位术中失血量为300 ml(200~600 ml)。术后3例出现并发症,包含淋巴囊肿、尿路感染以及下肢深静脉血栓。中位随访时间为283 d(128~715 d),其间4例无瘤生存,1例因疾病进展而死亡。高的R0切除率和可观的肿瘤学结局提示LEER可能作为骨盆侧壁受累的晚期复发妇科恶性肿瘤患者的替代治疗选择。

To explore the feasibility and safety of laterally extended endopelvic resection(LEER)for advanced and recurrent gynecological malignancies with pelvic sidewall involvement and to evaluate this therapeutic potential of this novel salvage treatment.The clinicopathological data of 5 patients with gynecological malignancies who received laparoscopic LEER treatment in Obstetrics and Gynecology Hospital of Fudan University from January 2019 to September 2021 were retrospectively analyzed,including 3 cases of recurrent cervical cancer,1 case of primary advanced endometrial cancer and 1 case of pelvic aggressive angiomyxoma.Among them,four patients achieved complete resection(R0)with a negative resection margin;the other patient with recurrent cervical cancer did not complete surgery because of the extreme risk of continuing surgery.The median operation time was 345(225-482)minutes and the median blood loss was approximately 300(200-600)ml.Complications occurred in three patients,including lymphocysts,urinary tract infections,and deep venous thrombosis of the lower extremities.Within a median follow-up time of 283(128-715)days,4 patients survived tumor-free,and 1 patient died.The high rate of complete resection(R0)and the encouraging oncological outcomes suggest that LEER may be an alternative treatment option for patients with advanced and recurrent gynecological malignancies involving the pelvic sidewall.