Stefanović A, Jeremić K, Kadija S, Milincić N, Mircić A, Petković S, Zizić V
Institute of Gynecology and Obstetrics, Medical School, University of Belgrade, Clinical Center of Serbia, Belgrade, Serbia.
Eur J Gynaecol Oncol. 2011;32(4):419-22.
In cases of advanced ovarian cancer bowel surgery is necessary during the primary surgical procedure, in the course of the disease for recurrence or palliation of the symptoms. Treatment with maximal cytoreductive surgery followed by chemotherapy in women with advanced ovarian cancer is well established.
We retrospectivly evaluated 56 women who were surgically treated for ovarian cancer over five years (from 2004 to 2008) at the Institute of Obstetrics and Gynecology, Clinical Center of Serbia. In 56 patients, 82 intestine operations were performed, which means that in some patients more than one intestine operation was performed. We analyzed patient characteristics, tumor features, intraoperative findings, pelvic node involvement, surgical procedure performed, indications for bowel surgery, and early postoperative complications.
In our study the majority of patients had Stage III (82%) or IV (10%) carcinoma with poor differentiation. Epithelial ovarian cancer was the most common histopathological finding (78%) in our group of patients. There were 30 cases (53%) with serous, nine (16%) with mucinous and five (9%) with endometriod tumors. Bowel surgery was indicated in 12.2% of our patients with ovarian cancer which was mostly performed to reduce the volume of the tumor (68%), while it was indicated in recurrence of the disease in 18% of women. In addition to the standard surgery procedure, which includes removal of internal genital organs, omentum minus/majus, peritoneal tumor masses, large and small bowel resection were performed. Of 56 patients most underwent small bowel surgery--43 of a total of 82 intestinal operations (52.4%). Of these we performed small bowel resection in 34 (41.5% of all intestinal operations), while ileostomy and jejunostomy were performed in nine cases (11%). There were 39 colon operations (47.6%) and most of the cases underwent rectosygmoid resection with the Hartman procedure (33 or 40.2% of all intestinal operations). Other colon operations included hemicolectomy (3 cases--3.7%), transverse colon resection (2 cases--2.4%) and pancolectomy (1 case--1.2%). According to our experience, wound infection and febrile morbidity were the most common early postoperative complications. Mortality rates in the literature vary between 0% and 8%, and anastomotic complications between 0 and 4%, which is in agreement with our results.
Radical surgical procedures in treatment of ovarian cancer including multi-organ resection are necesery to achieve a minimal residual disease state prior to initiating adjuvant chemotherapy. Bowel preparation and CT/MR imaging should be performed in patients with possible malignant ovarian masses.
在晚期卵巢癌病例中，在初次手术过程中、疾病复发过程中或为缓解症状时，肠道手术是必要的。对于晚期卵巢癌女性患者，先进行最大限度的肿瘤细胞减灭术，然后进行化疗，这种治疗方法已得到广泛认可。
我们回顾性评估了塞尔维亚临床中心妇产科研究所5年内（2004年至2008年）接受卵巢癌手术治疗的56名女性患者。56例患者共进行了82次肠道手术，这意味着部分患者接受了不止一次肠道手术。我们分析了患者特征、肿瘤特征、术中发现、盆腔淋巴结受累情况、所实施的手术程序、肠道手术指征以及术后早期并发症。
在我们的研究中，大多数患者患有III期（82%）或IV期（10%）低分化癌。上皮性卵巢癌是我们这组患者中最常见的组织病理学发现（78%）。有30例（53%）为浆液性肿瘤，9例（16%）为黏液性肿瘤，5例（9%）为子宫内膜样肿瘤。12.2%的卵巢癌患者需要进行肠道手术，其中大部分手术（68%）是为了缩小肿瘤体积，18%的女性患者是因为疾病复发而进行肠道手术。除了标准手术程序，包括切除内生殖器、大网膜、腹膜肿瘤块外，还进行了大肠和小肠切除术。56例患者中，大多数接受了小肠手术——82次肠道手术中有43次（52.4%）。其中，我们进行了34次小肠切除术（占所有肠道手术的41.5%），9例（11%）进行了回肠造口术和空肠造口术。有39次结肠手术（47.6 %），大多数病例采用Hartman手术进行直肠乙状结肠切除术（33次，占所有肠道手术的40.2%）。其他结肠手术包括半结肠切除术（3例，3.7%）、横结肠切除术（2例，2.4%）和全结肠切除术（1例，1.2%）。根据我们的经验，伤口感染和发热性疾病是最常见的术后早期并发症。文献报道的死亡率在0%至8%之间，吻合口并发症发生率在0%至4%之间，这与我们的结果一致。
在晚期卵巢癌的治疗中，包括多器官切除的根治性手术对于在开始辅助化疗前达到最小残留病灶状态是必要的。对于可能患有恶性卵巢肿块的患者，应进行肠道准备和CT/MR成像检查。
