Dept. of Gynecology & Gynecologic Oncology, HSK, Dr. Horst Schmidt Klinik, Ludwig-Erhard Str. 100, 65199 Wiesbaden, Germany.
Surg Oncol. 2012 Mar;21(1):31-5. doi: 10.1016/j.suronc.2010.08.006. Epub 2010 Sep 27.
Surgery is the mainstay of treatment for early ovarian cancer both as therapeutic and comprehensive staging. Only the latter allows appropriate tailoring of systemic treatment. However, the compliance with guidelines for comprehensive staging has been reported to be only moderate and, therefore, re-staging procedures are commonly indicated to avoid undertreatment. The purpose of our study was to evaluate re-operation in a tertiary gynecologic oncology unit after primary operation for presumably ovarian cancer FIGO I-IIIA in general gynecology departments.
Forty consecutive patients after primary surgery in the outside institutions for presumed early ovarian cancer with assumed tumor spread limited to the pelvis (FIGO I-IIIA) admitted to our department between 1999 and 2007 were included. In 35 cases re-staging surgery in our unit was indicated. The intra- and post-operative results were compared with initial diagnosis and sites of undetected disease were evaluated. Reasons for re-staging and referral pattern were studied.
40 patients were enrolled of whom 53% came by self-referral. Only 18% were referred by the primary surgeon and the remaining patients were referred by their home gynecologist. Only 5 patients (13%) were classified as having had a comprehensive staging by surgical records and pathology reports and 35 patients underwent comprehensive re-staging laparotomy after which 20 patients (50%) experienced an upstaging including 13 patients with final diagnosis of FIGO stage IIIC. Most frequent sites of primarily undetected tumor were peritoneum (pelvic 34%, diaphragm 13%, paracolic 8%), lymph nodes (para aortic 32%, pelvic 11%), intestines 24%, and residual omental tissue 18%. The indication for post-operative chemotherapy was modified in 53% of patients.
Comprehensive staging of presumed early ovarian cancer has been described as major problem especially outside gynecologic oncology units. Re-staging results in our department confirmed this deficiency by showing a considerable proportion of upstaging associated with alterations of recommendations for systemic treatment. However, series like this may even underestimate the problem, because incomplete staging is unfortunately accompanied by non-systematic referral practices not reflecting staging quality.
手术是治疗早期卵巢癌的主要手段，既是治疗手段，也是综合分期手段。只有后者才能进行适当的系统治疗。然而，据报道，综合分期的指南遵循率仅为中等水平，因此通常需要进行再分期手术以避免治疗不足。我们的研究目的是评估在普通妇科科室进行初步手术治疗疑似卵巢癌FIGO I-IIIA 后，在三级妇科肿瘤学单位进行再次手术的情况。
1999 年至 2007 年间，我们科室收治了 40 例在外部机构接受初步手术治疗疑似早期卵巢癌的连续患者，这些患者的肿瘤扩散被认为局限于盆腔（FIGO I-IIIA）。在我们科室，35 例患者需要进行再分期手术。比较了手术的围手术期结果，并评估了未检测到疾病的部位。研究了再分期的原因和转诊模式。
共纳入 40 例患者，其中 53%为自行转诊，仅 18%由初级外科医生转诊，其余患者由家庭妇科医生转诊。只有 5 例（13%）根据手术记录和病理报告被归类为进行了全面分期，35 例患者接受了全面再分期剖腹手术，其中 20 例（50%）出现分期升级，包括最终诊断为 FIGO 分期 IIIC 的 13 例患者。主要初次未检出肿瘤的部位是腹膜（盆腔 34%，膈肌 13%，结肠旁 8%）、淋巴结（主动脉旁 32%，盆腔 11%）、肠 24%和残留的网膜组织 18%。53%的患者术后化疗的指征发生了改变。
综合分期疑似早期卵巢癌被描述为一个主要问题，特别是在妇科肿瘤学单位之外。我们科室的再分期结果证实了这一缺陷，显示出相当比例的分期升级与系统治疗建议的改变相关。然而，这样的系列研究甚至可能低估了这个问题，因为不完整的分期伴随着非系统性的转诊实践，而这些实践并不能反映分期质量。
