Department of Gynecology and Gynecologic Oncology, Dr Horst Schmidt Klinik, Wiesbaden, Germany.
Int J Gynecol Cancer. 2010 Jan;20(1):41-6. doi: 10.1111/IGC.0b013e3181c443ba.
Laparoscopy is the standard procedure to clarify undefined ovarian masses. However, laparoscopy could induce tumor spread in ovarian cancer (OC). The aim of this study was to assess the incidence, the risk factors, and the complications of abdominal wall metastases (AWM) in patients with OC after laparoscopy.
Retrospective study of patients with primary diagnosis of OC who had laparoscopy before cytoreductive surgery and resected port sites in laparotomy between 1999 and 2008 at our institution. Patients with borderline or nonepithelial ovarian tumors were excluded.
Of 537 patients with a first diagnosis of OC, 101 had laparoscopy before definitive operation after a median of 31 days. Histological examination at final cytoreductive surgery of the port sites was conducted in 66 patients, whereas 31 patients (47%) showed AWM. Patients experiencing AWM had higher tumor stages and peritoneal carcinomatosis. Ascites with more than 500 mL was a further independent risk factor for AWM (odds ratio: 7.2; 95% confidence interval, 1.5-35.8; P = 0.016). Abdominal wall metastasis did not impact on survival in our cohort; however, affected patients showed significant larger abdominal wall resections (mean [SD]): 41.0 (angled brace 13.1) cm versus 9.1 (angled brace 1.4) cm in comparison with patients without AWM (P = 0.013), and 2 patients developed abdominal wall recurrences.
The incidence of AWM in patients experiencing OC was considerably high when laparoscopic surgery was conducted before cytoreductive surgery. Patients experiencing AWM seem to have more surgical burden. However, our series did not show a dramatic impact of AWM on long-term outcome. Patients with highly suspected advanced OC and ascites with more than 500 mL should be referred directly to a gynecologic oncologist who is able to balance risks of laparoscopic staging and direct cytoreductive surgery.
腹腔镜检查是明确卵巢不明肿块的标准程序。然而，腹腔镜检查可能会导致卵巢癌（OC）肿瘤扩散。本研究旨在评估在我院接受腹腔镜检查后行细胞减灭术的 OC 患者中腹壁转移（AWM）的发生率、危险因素和并发症。
回顾性研究 1999 年至 2008 年间在我院首次诊断为 OC 并在细胞减灭术前接受腹腔镜检查且在剖腹手术中切除切口部位的患者。排除交界性或非上皮性卵巢肿瘤患者。
在 537 例首次诊断为 OC 的患者中，有 101 例在中位时间为 31 天后在明确手术前接受了腹腔镜检查。对 66 例切口部位的最终细胞减灭术进行了组织学检查，其中 31 例（47%）出现 AWM。发生 AWM 的患者肿瘤分期和腹膜癌病更高。腹水超过 500 mL 是 AWM 的另一个独立危险因素（优势比：7.2；95%置信区间，1.5-35.8；P = 0.016）。在我们的队列中，AWM 并未影响患者的生存；然而，受影响的患者接受了更大的腹壁切除术（平均值[标准差]）：41.0（斜杠 13.1）cm 与无 AWM 的患者（9.1（斜杠 1.4）cm）相比（P = 0.013），且有 2 例患者出现腹壁复发。
在 OC 患者接受细胞减灭术前行腹腔镜手术时，AWM 的发生率相当高。发生 AWM 的患者似乎有更大的手术负担。然而，我们的系列研究并未显示 AWM 对长期预后有显著影响。对于高度怀疑晚期 OC 且腹水超过 500 mL 的患者，应直接转介给能够平衡腹腔镜分期和直接细胞减灭术风险的妇科肿瘤医生。
Zotero 插件