Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium.
Gynecol Oncol. 2010 Mar;116(3):489-96. doi: 10.1016/j.ygyno.2009.07.014. Epub 2009 Dec 1.
The aim of this study was to describe the role of diaphragmatic surgery in achieving optimal debulking in patients with advanced ovarian cancer and the assessment of the relative post-operative complications.
Retrospective review was performed of medical records of 89 patients with epithelial ovarian cancer who underwent diaphragmatic surgery during their primary debulking surgery between September 1993 and December 2007. Four different approaches were performed: coagulation (group 1), stripping (group 2), combination stripping with coagulation (group 3) and diaphragm full thickness resection (group 4). Cytoreductive outcome, morbidity, overall survival (OS) and disease-free survival (DFS) were analysed.
Eight (8.9%) patients had FIGO stage IIIB, 64 (72%) stage IIIC and 17 (19.1%) stage IV disease. In 20 patients (22%) the diaphragmatic disease was coagulated, in 31 patients (35%) was only stripped, in 31 patients (35%) a combination of these techniques was applied and in 7 (8%) the disease was resected with the adjacent infiltrated part of the diaphragm muscle and the pleura above it. Debulking to no residual tumor was achieved in 90%, 86%, 86% and 100% for groups 1, 2, 3 and 4 respectively. Median DFS was 15, 15, 17 and overall survival OS for groups 1, 2, and 3 was 40, 42, and 50 months respectively and was not yet reached for group 4. Minor and major complications were comparable among the groups. Pleural effusion was the most frequent associated complication and chest tube placement (17%) or thoracocentesis (12%) was necessary for the relief of respiratory distress. The perioperative mortality rate was 0%. The majority of cases were treated in the last five years of our 15-year experience.
Diaphragmatic surgery increases the rates of optimal primary debulking surgery and improves survival with an acceptable and manageable morbidity rate. In patients with thick (>0.3 cm) or large (>4 cm) lesions stripping the diaphragm or full thickness resection of the diaphragmatic muscle is preferred.
本研究旨在描述膈切除术在实现晚期卵巢癌患者最佳减瘤中的作用，并评估相关术后并发症。
对 1993 年 9 月至 2007 年 12 月期间接受初次减瘤手术中膈切除术的 89 例上皮性卵巢癌患者的病历进行回顾性分析。共施行 4 种不同的膈切除术方式：电凝（第 1 组）、剥离（第 2 组）、电凝联合剥离（第 3 组）和膈全层切除术（第 4 组）。分析减瘤效果、发病率、总生存期（OS）和无病生存期（DFS）。
8 例（8.9%）患者为FIGO 分期 IIIB 期，64 例（72%）为 IIIC 期，17 例（19.1%）为 IV 期。20 例（22%）患者的膈部病变采用电凝法，31 例（35%）采用单纯剥离法，31 例（35%）采用上述两种方法联合治疗，7 例（8%）采用膈全层切除术，同时切除受累的膈肌及其上方的胸膜。第 1、2、3 和 4 组的无残余肿瘤减瘤率分别为 90%、86%、86%和 100%。第 1、2 和 3 组的中位 DFS 分别为 15、15、17 个月，OS 分别为 40、42 和 50 个月，第 4 组尚未达到。各组的轻微和严重并发症相当。胸腔积液是最常见的相关并发症，需放置胸腔引流管（17%）或胸腔穿刺（12%）以缓解呼吸困难。围手术期死亡率为 0%。大多数病例是在我们 15 年经验的最后 5 年中治疗的。
膈切除术提高了最佳初次减瘤手术的比例，并提高了生存率，同时具有可接受和可控的发病率。对于厚（>0.3cm）或大（>4cm）病变的患者，建议行膈剥离或膈全层切除术。
