Magtibay Paul M, Adams Peter B, Silverman M Bradley, Cha Stephen S, Podratz Karl C
Division of Gynecologic Oncology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
Gynecol Oncol. 2006 Aug;102(2):369-74. doi: 10.1016/j.ygyno.2006.03.028. Epub 2006 Apr 24.
Epithelial ovarian carcinoma with extensive upper abdominal disease may require splenectomy for optimal tumor cytoreduction. We describe patients who required splenectomy during tumor reduction procedures for primary or recurrent epithelial ovarian carcinoma.
Data were abstracted from records of 112 patients who underwent splenectomy as part of primary or secondary cytoreductive surgery.
Of 112 patients, 66 had primary and 46 had secondary cytoreduction. Some patients also required bowel resection (50%), formal lymphadenectomy (31%), or urinary tract resection (5%). The most common indications for splenectomy were direct metastatic involvement (46%), facilitation of an en bloc resection of perisplenic disease (41%), and intraoperative trauma (13%). Histologically, 65% had hilar involvement; 52%, capsular involvement; and 16%, parenchymal metastases. Short-term complications included wound infections (7), pneumonias (5), thromboembolic events (9), and sepsis (5). Sepsis was associated with an anastomotic bowel leak in 1 patient, with fungal infections in 2 patients (1 pneumonia and 1 pelvic abscess), and with no identifiable infectious source in 2. Two patients required reoperation for bleeding: 1 for diffuse intraabdominal bleeding, including the splenic bed, and 1 for pelvic sidewall bleeding. The perioperative mortality rate at splenectomy was 5%: 3 from sepsis (1 anastomotic leak, 2 pneumonias), 2 from pulmonary embolism, and 1 for which the precise cause of death was not ascertainable. The primary cytoreduction group had a median survival of 1.8 years, with an estimated 2-year survival rate of 46%. The median survival in the secondary debulking group was 1.7 years, with an estimated 2-year survival of 42%.
In patients with clinically significant upper abdominal disease, splenectomy as part of primary or secondary cytoreductive surgery is associated with modest morbidity and mortality. The risk-benefit ratio of aggressive surgical cytoreduction must be considered.
对于伴有广泛上腹部病变的上皮性卵巢癌，可能需要行脾切除术以实现最佳的肿瘤细胞减灭。我们描述了在原发性或复发性上皮性卵巢癌肿瘤细胞减灭术中需要行脾切除术的患者。
数据取自112例行脾切除术作为原发性或继发性细胞减灭术一部分的患者的病历。
112例患者中，66例行原发性细胞减灭术，46例行继发性细胞减灭术。部分患者还需要行肠切除术（50%）、正规淋巴结清扫术（31%）或尿路切除术（5%）。脾切除术最常见的指征是直接转移累及（46%）、便于整块切除脾周病变（41%）和术中创伤（13%）。组织学检查显示，65%有肝门受累；52%有包膜受累；16%有实质转移。短期并发症包括伤口感染（7例）、肺炎（5例）、血栓栓塞事件（9例）和脓毒症（5例）。1例脓毒症与肠吻合口漏有关，2例与真菌感染有关（1例肺炎和1例盆腔脓肿），2例未发现明确的感染源。2例患者因出血需要再次手术：1例因包括脾床在内的弥漫性腹腔内出血，1例因盆腔侧壁出血。脾切除术中围手术期死亡率为5%：3例死于脓毒症（1例吻合口漏，2例肺炎），2例死于肺栓塞，1例确切死因不明。原发性细胞减灭术组的中位生存期为1.8年，估计2年生存率为46%。继发性肿瘤细胞减灭术组的中位生存期为1.7年，估计2年生存率为42%。
对于有临床意义的上腹部病变患者，作为原发性或继发性细胞减灭术一部分的脾切除术，其发病率和死亡率适中。必须考虑积极手术细胞减灭的风险效益比。
