Tozzi Roberto, Köhler Christhardt, Ferrara Alfonso, Schneider Achim
Department of Gynecology, Friedrich Schiller University, Jena, Germany.
Gynecol Oncol. 2004 Apr;93(1):199-203. doi: 10.1016/j.ygyno.2004.01.004.
To investigate the feasibility and safety of laparoscopic surgery in patients with early ovarian cancer.
Between 05-1996 and 06-2003, 24 patients with ovarian cancer FIGO stage IA-B underwent either primary treatment or completion of staging by laparoscopy. Laparoscopic staging was performed according to the FIGO guidelines, which entails one-sided oophorectomy or bilateral salpingo-ophorectomy with laparoscopic-assisted vaginal hysterectomy, pelvic lymphadenectomy, infrarenal para-aortic lymphadenectomy, complete resection of the infundibulo-pelvic ligament, appendectomy and partial omentectomy.
Eleven out of 24 patients (45.8%) underwent completion of staging after a mean of 12 days (range 4-21) after primary surgery, while 13 patients out of 24 (54.2%) underwent primary laparoscopic management of an adnexal mass, diagnosed as ovarian cancer by frozen section. Mean operative time was 166 min (range 118-206) for completion of staging and 182 min (range 141-246) for primary surgery. No major intraoperative complication occurred. One out of 24 patients (4.1%) developed chylos ascites postoperatively, which was managed conservatively. Five out of 24 patients (20.8%) received adjuvant chemotherapy after a median time of 7 days (mean 5-14) following surgery. No trocar metastasis occurred. Median follow-up is 46.4 months (range 2-72). Two out of 24 patients (8.3%) developed recurrence, which was treated with resurgery and chemotherapy. After a median follow-up of 46 months, disease-free survival is 91.6% and overall survival 100%.
Laparoscopic management of early ovarian cancer is safe and effective and survival outcome seems acceptable.
探讨腹腔镜手术用于早期卵巢癌患者的可行性及安全性。
在1996年5月至2003年6月期间，24例国际妇产科联盟（FIGO）分期为IA - B期的卵巢癌患者接受了腹腔镜下的初始治疗或分期手术。腹腔镜分期手术按照FIGO指南进行，包括单侧卵巢切除术或双侧输卵管卵巢切除术并辅以腹腔镜辅助阴式子宫切除术、盆腔淋巴结清扫术、肾下主动脉旁淋巴结清扫术、完整切除骨盆漏斗韧带、阑尾切除术及部分大网膜切除术。
24例患者中有11例（45.8%）在初次手术后平均12天（范围4 - 21天）接受了分期手术，24例中的13例（54.2%）接受了附件肿块的腹腔镜初始治疗，术中经冰冻切片诊断为卵巢癌。分期手术的平均手术时间为166分钟（范围118 - 206分钟），初始手术的平均手术时间为182分钟（范围141 - 246分钟）。术中未发生重大并发症。24例患者中有1例（4.1%）术后出现乳糜腹水，经保守治疗。24例患者中有5例（20.8%）在术后中位时间7天（平均5 - 14天）接受了辅助化疗。未发生穿刺孔转移。中位随访时间为46.4个月（范围2 - 72个月）。24例患者中有2例（8.3%）复发，接受了再次手术及化疗。中位随访46个月后，无病生存率为91.6%，总生存率为100%。
腹腔镜治疗早期卵巢癌安全有效，生存结果似乎可以接受。
