减瘤手术联合器官切除治疗晚期卵巢癌。

Cytoreductive surgery combined with organ resection for advanced ovarian carcinoma.

作者信息

Todo Yukiharu, Sakuragi Noriaki, Oikawa Mamoru, Negishi Hiroaki, Yamamoto Ritsu, Yoshiaki Ken, Tsumura Norihiko, Kawaguchi Isao, Fujimoto Seiichiro

机构信息

Department of Obstetrics and Gynecology, Hokkaido University School of Medicine, Kita-15, Nishi-7, Kita-Ku, Sapporo 060-8638, Japan.

出版信息

Int J Clin Oncol. 2003 Apr;8(2):90-6. doi: 10.1007/s101470300016.

DOI:10.1007/s101470300016

PMID:12720101

Abstract

BACKGROUND

The survival effects of combined organ resection in cytoreductive surgery for advanced ovarian carcinoma with regard to the site and the number of organs involved have not yet been clarified.

METHODS

Data obtained from 143 patients with stage III/IV ovarian carcinoma were used for analysis. Combined organ resection (COR) was employed in 21 patients in whom optimal cytoreduction (defined as a residuum <or=2 cm in diameter) was expected to be achieved by the procedure.

RESULTS

The tumors were optimally cytoreduced in 98 (68.5%) of 143 patients, either in primary surgery ( n = 53) or in interval cytoreductive surgery ( n = 45). The overall survival of patients with optimal cytoreduction was significantly higher than that of patients with nonoptimal cytoreduction ( P < 0.01). There was no significant difference between the survival of patients in the optimal primary cytoreduction group and that of patients in the optimal interval cytoreduction group. The survival of stage III patients who underwent optimal surgery with COR was comparable to that of stage III patients who underwent optimal surgery without COR and was better than that of stage III patients who underwent nonoptimal surgery ( P < 0.01). However, no effect of COR on the survival of stage IV patients was found. In the group of stage III patients who underwent optimal surgery with COR, the survival time tended to be shorter in patients who had upper abdominal organ resections ( P = 0.059), and it was significantly shorter in patients who underwent resections of two or more organs ( P = 0.0299). There was no operative mortality in any of the patients who underwent COR.

CONCLUSION

Although COR has therapeutic significance for stage III ovarian carcinoma, the survival periods of patients with stage III ovarian carcinoma who have undergone additional upper abdominal organ resections, or two or more organ resections, may be shorter than the survival periods of patients with stage III ovarian carcinoma who have undergone resection of a single non-upper-abdominal organ.

摘要

背景

在晚期卵巢癌减瘤手术中，联合器官切除对生存的影响，关于受累器官的部位和数量尚未明确。

方法

从143例III/IV期卵巢癌患者获得的数据用于分析。21例患者采用联合器官切除（COR），预计通过该手术可实现最佳减瘤（定义为残留灶直径≤2 cm）。

结果

143例患者中有98例（68.5%）实现了最佳减瘤，其中53例在初次手术时实现，45例在间隔期减瘤手术时实现。最佳减瘤患者的总生存率显著高于未实现最佳减瘤的患者（P<0.01）。最佳初次减瘤组患者与最佳间隔期减瘤组患者的生存率无显著差异。接受COR的最佳手术的III期患者的生存率与未接受COR的最佳手术的III期患者相当，且优于接受非最佳手术的III期患者（P<0.01）。然而，未发现COR对IV期患者生存有影响。在接受COR的最佳手术的III期患者组中，进行上腹部器官切除的患者生存时间有缩短趋势（P = 0.059），进行两个或更多器官切除的患者生存时间显著缩短（P = 0.0299）。接受COR的患者均无手术死亡。