Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Gynecol Oncol. 2010 Mar;116(3):483-8. doi: 10.1016/j.ygyno.2009.09.047. Epub 2009 Nov 28.
To assess the utility of thoracoscopy in defining the extent of intrathoracic disease and survival outcomes in patients with moderate to large pleural effusions at the time of diagnosis of advanced ovarian carcinoma.
We reviewed the records of all patients with untreated advanced ovarian carcinoma and moderate to large pleural effusions who underwent video-assisted thoracoscopic surgery (VATS) our institution between 6/01 and 10/08. Demographic, clinicopathologic and outcome data were collected for all patients with a final diagnosis of ovarian carcinoma.
Forty-two patients met eligibility criteria, with a median age of 58 years; median CA-125 level of 1747 U/mL; and medium serum albumin of 3.9 g/dl. VATS was performed for right-sided effusions in 30 patients (71%). Macroscopic pleural disease was found in 29 patients (69%). Of the 11 patients with negative cytology, macroscopic pleural disease was found in 4 (36%). Intrathoracic cytoreductive surgery was performed in 6 (33%) of the 18 patients with intrathoracic disease >1 cm. After VATS, 29/42 (69%) patients underwent attempted primary abdominal surgical debulking. Thirteen patients (31%) received neoadjuvant chemotherapy. Twelve (92%) of these patients underwent interval cytoreductive surgery. Patients who were directed after VATS to neoadjuvant chemotherapy instead of primary surgical cytoreduction had a 2-year PFS rate of 22% compared to 42% for the primary cytoreductive group (P=0.36).
Overall, management was altered based on VATS findings in 43% of cases. Further investigation is needed to define the prognostic significance of VATS evaluation of the burden of pleural disease.
评估胸腔镜在诊断晚期卵巢癌时伴中大量胸腔积液患者中的应用价值，以明确胸腔内疾病的范围和生存结果。
我们回顾了 2001 年 6 月至 2008 年 10 月期间在我院接受电视辅助胸腔镜手术（VATS）的所有未经治疗的晚期卵巢癌伴中大量胸腔积液患者的病历。收集所有最终诊断为卵巢癌患者的人口统计学、临床病理和结局数据。
42 名患者符合入选标准，中位年龄为 58 岁；CA-125 水平中位值为 1747U/ml；血清白蛋白中位值为 3.9g/dl。30 名患者（71%）行右侧胸腔积液 VATS。29 名患者（69%）发现肉眼可见的胸膜疾病。11 名细胞学阴性患者中，4 名（36%）发现肉眼可见的胸膜疾病。18 例胸腔内疾病>1cm 的患者中，有 6 名（33%）行胸腔内细胞减灭术。VATS 后，42 名患者中有 29 名（69%）尝试行初次腹部手术去肿瘤。13 名患者（31%）接受新辅助化疗。其中 12 名（92%）患者接受了间隔性细胞减灭术。VATS 后接受新辅助化疗而不是初次手术细胞减灭术的患者 2 年无进展生存率为 22%，而初次手术细胞减灭术组为 42%（P=0.36）。
总体而言，43%的病例根据 VATS 结果改变了治疗方案。需要进一步研究来明确 VATS 评估胸腔内疾病负担的预后意义。
