Gynecologic Oncology Department, European Institute of Oncology, Milan, Italy.
Int J Gynecol Cancer. 2011 Dec;21(9):1698-703. doi: 10.1097/IGC.0b013e31822f65c3.
Standard approach for medically stable advanced ovarian cancer patients should be primary cytoreduction following platinum-based chemotherapy. The aim of surgical effort should be the complete removal of all visible disease. Our objective was to compare perioperative features, postoperative complications, and secondarily oncological outcomes of patients who underwent diaphragmatic stripping with those who underwent diaphragmatic resection for advanced ovarian cancer.
One hundred twelve cases were identified, among them 79 underwent diaphragmatic stripping and 33 underwent diaphragmatic full-thickness resection. Data collected included patients' age, all perioperative details and pathological findings, International Federation of Gynecology and Obstetrics stage, adjuvant therapy, and follow-up data.
Larger residual tumors (mean, 5.1 vs 1.6 mm, respectively; P < 0.01) but shorter operating time (25 minutes shorter operative time, P = 0.07) were observed in the stripping group. Higher postoperative pleural effusions rates (63.6% vs 37.9%, P = 0.01), but no differences in the remaining complications, were observed in the resection group. After a mean of 31 months of follow-up, disease-free survival rates were 27.8% in the stripping group and 39.4% in the resection group (P = 0.04). No significant differences were observed for overall survival.
Diaphragmatic surgery at the time of primary cytoreductive surgery for advanced ovarian cancer may contribute to the achievement of complete cytoreduction with low perioperative complication rate; full-thickness resection is preferable if peritoneum stripping will not achieve a complete removal of the disease.
对于医学稳定的晚期卵巢癌患者，标准治疗方法应该是在铂类化疗后进行初次细胞减灭术。手术的目的应该是彻底清除所有可见的疾病。我们的目的是比较行膈肌剥离术和膈肌全切除术的晚期卵巢癌患者的围手术期特征、术后并发症和继发肿瘤学结局。
共确定了 112 例患者，其中 79 例行膈肌剥离术，33 例行膈肌全切除术。收集的数据包括患者年龄、所有围手术期细节和病理发现、国际妇产科联合会分期、辅助治疗和随访数据。
在剥离组中观察到更大的残留肿瘤（分别为 5.1 毫米和 1.6 毫米，P < 0.01），但手术时间更短（手术时间缩短 25 分钟，P = 0.07）。在切除组中观察到更高的术后胸腔积液发生率（63.6%比 37.9%，P = 0.01），但其他并发症无差异。在平均 31 个月的随访后，剥离组的无疾病生存率为 27.8%，切除组为 39.4%（P = 0.04）。两组的总生存率无显著差异。
在初次细胞减灭术时行膈肌手术可能有助于实现完全细胞减灭，且围手术期并发症发生率低；如果腹膜剥离不能完全清除疾病，则应行膈肌全切除术。
