Scarabelli C, Gallo A, Franceschi S, Campagnutta E, De G, Giorda G, Visentin M C, Carbone A
Division of Gynecologic Oncology, Centro di Riferimento Oncologico di Aviano, Istituto Nazionale di Ricovero e Cura a Carattere Scientifico; Aviano, Italy.
Cancer. 2000 Jan 15;88(2):389-97. doi: 10.1002/(sici)1097-0142(20000115)88:2<389::aid-cncr21>3.0.co;2-w.
The impact of radical bowel resection with multiple organ resection on the survival if patients with advanced ovarian carcinoma has not been well defined. The authors investigated whether primary cytoreductive surgery including rectosigmoid colon resection would affect the recurrence free interval and survival of these patients.
Between April 1990 and April 1997, 66 previously untreated Stage IIIC-IV ovarian carcinoma patients with macroscopic involvement of the rectosigmoid colon were enrolled. All patients underwent cytoreductive surgery with rectosigmoid colon resection to remove residual tumor less than 2 cm in greatest dimension and received 6 cycles of cisplatin-based postoperative chemotherapy.
The median follow-up was 26 months (range, 7-104 months). In multivariate analysis, residual disease and depth of tumor infiltration of the bowel wall were independently associated with overall survival and recurrence free interval. Disease stage was independently associated only with overall survival. Residual tumor was the most strongly predictive factor for recurrence or death. The 2-year estimated survival rates according to the amount of residual tumor were 100% for 24 patients with no macroscopic residual disease and 77.3% for 28 patients with residual disease less than 1 cm. None of the 14 patients with residual disease larger than 1 cm were alive 2-years after operation. Overall, 48 patients (72.7%) developed disease recurrence: 43 (65.1%) in the abdomen, 19 (29.8%) in the liver, and 3 (4.5%) in the pelvis.
The current findings suggest that cytoreductive surgery with rectosigmoid colon resection should be considered for ovarian carcinoma patients with bulky pelvic disease to help ensure that they are left with no residual disease after debulking surgery.
广泛肠切除联合多器官切除对晚期卵巢癌患者生存的影响尚未明确界定。作者研究了包括直肠乙状结肠切除在内的初次肿瘤细胞减灭术是否会影响这些患者的无复发生存期和生存率。
在1990年4月至1997年4月期间，纳入66例先前未经治疗、直肠乙状结肠有肉眼可见受累的IIIC-IV期卵巢癌患者。所有患者均接受了直肠乙状结肠切除的肿瘤细胞减灭术，以清除最大直径小于2 cm的残留肿瘤，并接受6个周期的顺铂辅助化疗。
中位随访时间为26个月（范围7 - 104个月）。多因素分析显示，残留病灶和肠壁肿瘤浸润深度与总生存期和无复发生存期独立相关。疾病分期仅与总生存期独立相关。残留肿瘤是复发或死亡的最强预测因素。根据残留肿瘤量，24例无肉眼可见残留病灶患者的2年估计生存率为100%，28例残留病灶小于1 cm患者的2年估计生存率为77.3%。14例残留病灶大于1 cm的患者术后2年无一存活。总体而言，48例患者（72.7%）出现疾病复发：43例（65.1%）发生在腹部，19例（29.8%）发生在肝脏，3例（4.5%）发生在盆腔。
目前的研究结果表明，对于盆腔肿块较大的卵巢癌患者，应考虑行直肠乙状结肠切除的肿瘤细胞减灭术，以确保肿瘤细胞减灭术后无残留病灶。
