Bristow Robert E, del Carmen Marcela G, Kaufman Howard S, Montz Fredrick J
Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
J Am Coll Surg. 2003 Oct;197(4):565-74. doi: 10.1016/S1072-7515(03)00478-2.
The aim of this study was to describe the feasibility, associated morbidity, and efficacy of radical oophorectomy with primary stapled colorectal anastomosis among patients with locally advanced ovarian cancer with contiguous extension to or encasement of the reproductive organs, pelvic peritoneum, cul-de-sac, and sigmoid colon.
Thirty-one consecutive patients undergoing radical oophorectomy as part of an initial maximal surgical effort for International Federation of Obstetrics and Gynecology (FIGO) stage IIIB-IV ovarian cancer were prospectively collected from October 1, 1997 through November 30, 2001. The surgical technique, associated morbidity, and clinical outcomes are described.
The median age was 63 years. All patients had advanced-stage epithelial ovarian cancer: FIGO stage IIIB (6.5%), stage IIIC (64.5%), stage IV (29.0%). Median operating time was 240 minutes (range 165 to 330 minutes), and the median estimated blood loss was 700 mL (range 300 to 2,900 mL). All patients underwent en bloc rectosigmoid colectomy with primary stapled anastomosis without protective intestinal diversion. There was one (3.2%) anastomotic breakdown requiring reoperation and colostomy. Complete clearance of macroscopic pelvic disease was achieved in all cases. Overall, 87.1% of patients were left with optimal (</=1 cm) residual disease and 61.3% were visibly disease free. There were no postoperative deaths, but major and minor postoperative morbidity occurred in 12.9% and 35.5% of patients, respectively. Blood product transfusion was required in 29.0% of cases. Thirty patients received multiagent platinum-based chemotherapy, with a median overall survival time of 39.5 months.
Radical oophorectomy with primary stapled anastomosis is an effective technique for resection of locally advanced ovarian cancer and contributes significantly to a maximal cytoreductive surgical effort. The associated morbidity is acceptable, and protective intestinal diversion appears unnecessary.
本研究的目的是描述在局部晚期卵巢癌侵犯或包绕生殖器官、盆腔腹膜、直肠子宫陷凹及乙状结肠的患者中，根治性卵巢切除术联合一期吻合器结直肠吻合术的可行性、相关发病率及疗效。
1997年10月1日至2001年11月30日期间，前瞻性收集了31例连续接受根治性卵巢切除术的患者，这些患者作为国际妇产科联盟（FIGO） IIIB-IV期卵巢癌初始最大程度手术治疗的一部分。描述了手术技术、相关发病率及临床结局。
中位年龄为63岁。所有患者均为晚期上皮性卵巢癌：FIGO IIIB期（6.5%）、IIIC期（64.5%）、IV期（29.0%）。中位手术时间为240分钟（范围165至330分钟），中位估计失血量为700毫升（范围300至2900毫升）。所有患者均接受了乙状结肠直肠整块切除术及一期吻合器吻合术，未行保护性肠造口术。有1例（3.2%）吻合口破裂需要再次手术并进行结肠造口术。所有病例均实现了肉眼可见盆腔病灶的完全清除。总体而言，87.1%的患者术后残留病灶最佳（≤1厘米），61.3%的患者肉眼无病灶。无术后死亡病例，但分别有12.9%和35.5%的患者发生了严重和轻微的术后并发症。29.0%的病例需要输血。30例患者接受了多药铂类化疗，中位总生存时间为39.5个月。
根治性卵巢切除术联合一期吻合器吻合术是切除局部晚期卵巢癌的有效技术，对最大程度的细胞减灭性手术有显著贡献。相关发病率可接受，且似乎无需行保护性肠造口术。
