Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Republic of Korea.
Gynecol Oncol. 2012 May;125(2):483-92. doi: 10.1016/j.ygyno.2012.02.024. Epub 2012 Feb 23.
Over the past 40 years, the survival of patients with advanced ovarian cancer has greatly improved due to the introduction of combination chemotherapy with platinum and paclitaxel as standard front-line treatment and the progressive incorporation of increasing degrees of maximal cytoreductive surgery. The designation of "optimal" surgical cytoreduction has evolved from residual disease ≤ 1 cm to no gross residual disease. There is a growing body of evidence that patients with no gross residual disease have better survival than those with optimal but visible residual disease. In order to achieve this, more radical cytoreductive procedures such as radical pelvic resection and extensive upper abdominal procedures are increasingly performed. However, some investigators still suggest that tumor biology is a major determinant in survival and that optimal surgery cannot fully compensate for tumor biology. The aim of this review is to outline the theoretical rationale and historical evolution of primary cytoreductive surgery, to re-evaluate the preferred surgical objective and procedures commonly required to achieve optimal cytoreduction in the platinum/taxane era based on contemporary evidence, and to redefine the concept of "optimal" residual disease within the context of future surgical developments and analysis of treatment outcomes.
在过去的 40 年中，由于引入了铂类和紫杉醇联合化疗作为标准一线治疗方案，以及不断增加最大限度减瘤手术的程度，晚期卵巢癌患者的生存率得到了极大提高。“最佳”手术减瘤的定义已经从残留病变≤1cm 演变为无肉眼残留病变。越来越多的证据表明，无肉眼残留病变的患者比有最佳但可见残留病变的患者生存更好。为了实现这一目标，越来越多的激进减瘤手术，如根治性盆腔切除术和广泛的上腹部手术，正在被施行。然而，一些研究人员仍认为肿瘤生物学是生存的主要决定因素，而最佳手术并不能完全弥补肿瘤生物学的缺陷。本综述的目的是概述原发性细胞减灭术的理论基础和历史演变，根据当代证据重新评估在铂类/紫杉烷时代实现最佳细胞减灭所需的首选手术目标和程序，并在未来的手术发展和治疗结果分析的背景下重新定义“最佳”残留病变的概念。
