Tinelli F G, Tinelli A, Campagnutta E, Kobal B, Rakar S, Manca C, Tinelli R, Perrone A
Unità Operativa di Ginecologia e Ostetricia, Ospedale Vito Fazzi, Lecce, Italy.
Minerva Ginecol. 2004 Oct;56(5):457-67.
Ovarian cancer is a tumor with a high trend of recurrence and this occurrence consistently increases the difficulty of the patient cure and reduces the efficacy of current treatments. The role of surgery in persistent or recurrent ovarian cancer is controversial and the type of surgery can be different according to the different stages and invasion of tumor; it can be a debulking surgery followed by chemotherapy (to eradicate the most part of ovarian cancer, leaving a minimal tumoral residue), an interval surgery (for advanced ovarian cancer stage in previously operated patients, followed by 2 or 3 inductive chemotherapy cycles and subsequently a cytoreductive redo surgery) and a cytoreductive secondary surgery, after optimal primary surgical treatment and minimal tumoral recurrence. In some cases it is possible either to perform a debulking surgery during a primary (after the conclusion of primary treatment) or a salvage or palliative surgery (to improve, after an acceptable time period, clinical symptoms in patients with progressive cancer or resistant to treatments). The aims of surgical therapy, to be performed in a patient with ovarian cancer relapse, are to reduce, as much as possible, the tumour size, to increase the quality of life and to increase the survival time; in this review different surgical techniques to be carried out in each case, selected for disease staging, for tumour cells kinetic and for surgical goals, are discussed.
卵巢癌是一种具有高复发倾向的肿瘤,这种情况持续增加了患者治愈的难度,并降低了当前治疗的效果。手术在持续性或复发性卵巢癌中的作用存在争议,手术类型会根据肿瘤的不同分期和侵犯情况而有所不同;它可以是减瘤手术后进行化疗(以根除大部分卵巢癌,留下最小的肿瘤残余)、间隔手术(用于先前接受过手术的晚期卵巢癌患者阶段,先进行2或3个诱导化疗周期,随后进行细胞减灭性再次手术)以及在最佳的初次手术治疗和最小肿瘤复发后进行的细胞减灭性二次手术。在某些情况下,既可以在初次手术(初次治疗结束后)期间进行减瘤手术,也可以进行挽救性或姑息性手术(在一段可接受的时间后,改善进展期癌症患者或对治疗耐药患者的临床症状)。在卵巢癌复发患者中进行手术治疗的目的是尽可能缩小肿瘤大小、提高生活质量并延长生存时间;在本综述中,讨论了针对每种情况根据疾病分期、肿瘤细胞动力学和手术目标选择实施的不同手术技术。