Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, CancerEst, Université Pierre et Marie Curie, Paris, France.
Int J Gynecol Cancer. 2012 Oct;22(8):1349-54. doi: 10.1097/IGC.0b013e318265d358.
Surgical management of advanced ovarian cancer often requires low modified posterior pelvic exenteration (MPE) to achieved complete resection. The aim of this study was to evaluate the morbidity of MPE at the time of primary cytoreductive surgery (PCS) and interval cytoreductive surgery (ICS) after neoadjuvant chemotherapy.
From 2001 to 2009, 63 patients underwent MPE for advanced ovarian cancer. We analyzed and compared surgical characteristics and postoperative courses between PCS and ICS.
Modified posterior pelvic exenteration was performed during PCS for 50 patients (79%) and during ICS for 13 patients (21%). Complete cytoreduction was achieved in 80% of patients (84% in the PCS group and 69% in the ICS group; ns). There was no significant difference between the PCS and ICS groups in the type and the rate of standards or radical surgical procedures. Patients with ICS had a shorter length of stay in the intensive care unit (0.9 vs 2.7 days; P = 0.009), but there was no difference in the total length of hospitalization (P = 0.94). The global rate of postoperative complications was 76%. No differences were found between the 2 groups in digestive or extradigestive complications, iterative surgery, or interventional radiology procedures. The median overall survival was 49.4 months in the PCS group and 27.1 months in the ICS group (P = 0.27), and the median progression-free survival time in both groups was 20 months.
There was no difference in the occurrence of postoperative complications between PCS and ICS, especially in morbidity related to MPE. The specific morbidity of this surgical procedure remained low compared with the overall morbidity in cases of extensive surgery.
高级卵巢癌的外科治疗通常需要进行改良后的后路盆腔廓清术（MPE）以实现完全切除。本研究旨在评估新辅助化疗后初次细胞减灭术（PCS）和间隔细胞减灭术（ICS）时 MPE 的发病率。
2001 年至 2009 年，63 例患者因晚期卵巢癌接受 MPE。我们分析并比较了 PCS 和 ICS 时的手术特点和术后过程。
50 例患者（79%）在 PCS 时行 MPE，13 例患者（21%）在 ICS 时行 MPE。80%的患者达到完全肿瘤减灭（PCS 组 84%，ICS 组 69%；无统计学差异）。PCS 组和 ICS 组标准或根治性手术的类型和比例无显著差异。ICS 组患者在重症监护病房的停留时间更短（0.9 天 vs 2.7 天；P = 0.009），但总住院时间无差异（P = 0.94）。术后并发症的总发生率为 76%。两组间在消化系统或消化系统外并发症、迭代手术或介入放射学程序方面无差异。PCS 组的中位总生存期为 49.4 个月，ICS 组为 27.1 个月（P = 0.27），两组的中位无进展生存期均为 20 个月。
PCS 和 ICS 之间术后并发症的发生无差异，尤其是与 MPE 相关的发病率。与广泛手术的总发病率相比，这种手术的具体发病率仍然较低。
