Daraï E, Tulpin L, Prugnolle H, Cortez A, Dubernard G
Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
Surg Endosc. 2007 Nov;21(11):2039-43. doi: 10.1007/s00464-007-9286-9. Epub 2007 May 19.
This study aimed to evaluate the feasibility and relevance of laparoscopic restaging surgery for women with borderline ovarian tumors.
From March 2001 to February 2006, 42 women referred for borderline ovarian tumors after laparoscopy or laparotomy underwent a laparoscopic restaging operation. Of these women, 37 (88%) had undergone conservative surgery including unilateral cystectomy (n = 16), bilateral cystectomy (n = 1), and unilateral salpingo-oophorectomy (n = 20). The remaining five women (12%) had undergone radical surgery, including bilateral salpingo-oophorectomy (BSO) (n = 4) and hysterectomy with BSO (n = 1). Intraoperative rupture occurred in 13 cases.
All 42 restaging operations were performed via the laparoscopic approach. There were no intraoperative complications, no laparoconversions, and no postoperative complications. Laparoscopic restaging identified two persistent borderline ovarian tumors (12%) in women who had initially undergone cystectomy. Seven women were upstaged (16.6%) because of positive cytology (n = 2), peritoneal biopsy (n = 2), or omentum (n = 3). Among the 28 women with initial Federation International of Gynaecology and Obstetrics (FIGO) stage Ia disease, the final stage was Ia for 24 women, Ib for 2 women, IIIa for 1 woman, and IIIc for 1 woman. Among the 12 women with initial stage Ic disease, 11 kept the same stage and 1 was upstaged to IIIc. The woman with initial stage IIa disease was upstaged to IIb, and the woman with initial stage IIc disease was upstaged to IIIc. The risk of upstaging was significantly higher among women with serous borderline tumors. Upstaging occurred in women with both initial stages I and II disease.
The results confirm the feasibility and safety of laparoscopic restaging operations for women with borderline ovarian tumors. Cystectomy was associated with a risk of persistent lesions. The risk of upstaging was higher for women with serous borderline ovarian tumors and women with initial FIGO stage I or II disease.
本研究旨在评估腹腔镜再分期手术对卵巢交界性肿瘤女性患者的可行性和相关性。
2001年3月至2006年2月，42例经腹腔镜检查或剖腹手术后被诊断为卵巢交界性肿瘤的女性接受了腹腔镜再分期手术。其中，37例（88%）接受了保守性手术，包括单侧囊肿切除术（n = 16）、双侧囊肿切除术（n = 1）和单侧输卵管卵巢切除术（n = 20）。其余5例（12%）接受了根治性手术，包括双侧输卵管卵巢切除术（BSO）（n = 4）和子宫切除术加BSO（n = 1）。术中破裂发生在13例患者中。
所有42例再分期手术均通过腹腔镜途径进行。术中无并发症，无中转开腹，术后也无并发症。腹腔镜再分期发现2例最初接受囊肿切除术的女性存在持续性卵巢交界性肿瘤（12%）。7例女性因细胞学阳性（n = 2）、腹膜活检阳性（n = 2）或大网膜阳性（n = 3）而分期上调（16.6%）。在最初国际妇产科联盟（FIGO）分期为Ia期的28例女性中，最终分期为Ia期的有24例，Ib期2例，IIIa期1例，IIIc期1例。在最初分期为Ic期的12例女性中，11例维持原分期，1例上调至IIIc期。最初为IIa期的女性上调至IIb期，最初为IIc期的女性上调至IIIc期。浆液性交界性肿瘤女性分期上调的风险显著更高。分期上调发生在最初为I期和II期疾病的女性中。
结果证实了腹腔镜再分期手术对卵巢交界性肿瘤女性患者的可行性和安全性。囊肿切除术与持续性病变的风险相关。浆液性卵巢交界性肿瘤女性以及最初FIGO分期为I期或II期疾病的女性分期上调的风险更高。
