卵巢低度恶性潜在肿瘤的保留生殖力的手术治疗

Objective. Ovarian low malignant potential (LMP) tumors have an excellent prognosis when treated by surgical resection. Conservative management usually involves leaving behind the uterus and contralateral adnexa to allow future childbearing. The purpose of this study was to determine the outcome of women treated with fertility-sparing surgery. Methods. All patients diagnosed with ovarian LMP tumors between 1984 and 2003 were identified at three institutions. Data were retrospectively extracted from clinical records. Results. Thirty eight (15% ) of 249 women with LMP tumors underwent fertility-sparing surgery. Twenty-three were nulliparous and four primiparous. Thirty-three (87% ) underwent unilateral salpingo-ophorectomy and five (13% ) cystectomy. Fourteen patients also had contralateral cystectomy or biopsy. Thirty four (89% ) were stage Ⅰ , one (3% ) stage Ⅱ and three (8% ) stage Ⅲ . Most tumors had serous (55% ) or mucinous (42% ) histology. No patients received adjuvant therapy. Six (16% ) of 38 recurred after a median follow-up of 26 months: five in the remaining ovary were salvaged with surgical resection alone, and none died from recurrent LMP tumor. Five women delivered six term infants during post-treatment surveillance. Conclusion. Fertility-sparing surgery for ovarian LMP tumors is an option for motivated patients. Preservation of the contralateral adnexa increases the risk of recurrence, but surgical resection is usually curative.

低恶性卵巢肿瘤的手术分期

OBJECTIVE: Women diagnosed with ovarian tumors of low malignant potential ha ve an excellent prognosis. Because few will receive adjuvant therapy, the benefit of surgical staging has recently been challenged. The purpose of this study was to compare the outcome of surgically staged patients with low malignant potentia l tumors with those who were not staged. METHODS: Between 1984 and 2003, all wom en with ovarian low malignant potential tumors were identified at 3 institutions . Data were extracted from clinical records. RESULTS: One hundred eighty-three (74%) of 248 women were surgically staged. Forty of 183 staged patients had cli nically obvious extraovarian disease. Forty (28%) of the remaining 143 women wi th disease apparently confined to the ovary were upstaged. Cytologic washings we re positive in 28 cases, 10 had microscopic implants detected by peritoneal or o mental biopsy, and 2 were upstaged to stage IIIC solely on the basis of nodal me tastases. One hundred eighteen women underwent pelvic node dissection (median: 5 nodes), and 86 underwent paraaortic node dissection (median: 2 nodes). Overall, 9 (1%) metastases were detected in 832 submitted pelvic nodes. All 314 paraaor tic nodes were negative. Intraoperative blood loss (P < .001) and length of hosp ital stay (P < .001) were increased in women without gross disease who were surg ically staged. Eight (3%) of 248 patients received adjuvant platinum-based che motherapy, but neither of the women upstaged to IIIC based on the results of the ir nodal dissection were treated. Fifteen (6%) recurrences developed and 1 (0.4 %) death occurred after a median follow-up of 28 (range, 1-208) months. CONCL USION: Routine pelvic and paraaortic lymph node dissection is not necessary in t he majority of women with ovarian low malignant potential rumors.

卵巢低度恶性潜能肿瘤手术分期的回顾性队列研究

Objective: The purpose of this study was to determine the benefit of surgically staging ovarian low malignant potential tumors. Study design: This was a retrospective cohort study of all ovarian low malignant potential tumors that were diagnosed by frozen section or final pathologic review from 2003 to 2005. Results: Twenty-two of 32 patients (69% ) were staged surgically. Sixteen low malignant potential tumors were stage I by final pathologic review, and 4 tumors were upstaged to stage II-III disease. Two other patients had early invasive ovarian carcinoma, despite a frozen section that suggested low malignant potential; 1 patient received adjuvant chemotherapy. The tumors of 10 women (31% ) were unstaged. Frozen section suspicion of low malignant potential (P = .003) and surgery by a gynecologic oncologist (P < .001) correlated with staging. Preoperative CA- 125, intraoperative blood loss, and postoperative hospitalization were increased in patients with staged disease (each P < .05). Two women who underwent fertility-sparing surgery experienced a recurrence in the contralateral ovary. Conclusion: Surgical staging of ovarian low malignant potential tumors has limited value for most patients, unless invasive carcinoma is diagnosed by final pathologic review.