Soper J T, Johnson P, Johnson V, Berchuck A, Clarke-Pearson D L
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
Obstet Gynecol. 1992 Dec;80(6):949-53.
To determine the yield and morbidity of comprehensive restaging laparotomy in women with presumed early ovarian carcinoma who have undergone incomplete initial staging procedures.
We conducted a retrospective review of 30 women with apparent early ovarian carcinoma who underwent a comprehensive restaging laparotomy including multiple random intraperitoneal biopsies and selective pelvic/para-aortic lymphadenectomy before receiving adjuvant therapy. Positive findings were compared with clinicopathologic features.
Only 17% of patients had adequate skin incisions, 53% had pelvic washings, and 37% had omental biopsy at primary surgery. Complications of restaging laparotomy included 53% severe adhesions, 20% bowel complications, and 20% vascular complications requiring suture. Nine patients (30%) had disease upstaged and six (20%) had stage III disease established by comprehensive restaging laparotomy. Two-thirds of the upstaged patients had occult metastases identified only through cytology, random peritoneal biopsies, or selective lymphadenectomy. Women with poorly differentiated or papillary serous lesions were more likely to have disease upstaged than those with well- and moderately differentiated lesions or other histologic types (P < .05). Other clinicopathologic features did not predict upstaging.
A comprehensive staging laparotomy is needed to detect occult metastatic disease in women with apparent early ovarian carcinoma.
确定接受初始分期程序不完整的疑似早期卵巢癌女性患者进行全面再分期剖腹手术的检出率及发病率。
我们对30例疑似早期卵巢癌女性患者进行了回顾性研究，这些患者在接受辅助治疗前接受了包括多次随机腹膜内活检和选择性盆腔/腹主动脉旁淋巴结清扫术在内的全面再分期剖腹手术。将阳性结果与临床病理特征进行比较。
仅17%的患者在初次手术时有足够的皮肤切口，53%有盆腔冲洗液，37%有网膜活检。再分期剖腹手术的并发症包括53%的严重粘连、20%的肠道并发症以及20%需要缝合的血管并发症。9例患者（30%）疾病分期上调，6例（20%）通过全面再分期剖腹手术确诊为III期疾病。三分之二分期上调的患者仅通过细胞学检查、随机腹膜活检或选择性淋巴结清扫术发现隐匿性转移。低分化或乳头状浆液性病变的女性比高分化和中分化病变或其他组织学类型的女性更有可能出现疾病分期上调（P < 0.05）。其他临床病理特征不能预测分期上调。
对于疑似早期卵巢癌的女性患者，需要进行全面分期剖腹手术以检测隐匿性转移性疾病。
