Division of Minimally Invasive Ginecological Surgery - St. Maria Hospital - University of Perugia, Terni, Italy.
Gynecol Oncol. 2013 Nov;131(2):341-6. doi: 10.1016/j.ygyno.2013.08.005. Epub 2013 Aug 9.
To evaluate the prognostic impact of routinely use of staging laparoscopy (S-LPS) in patients with primary advanced epithelial ovarian cancer (AEOC).
All women were submitted to S-LPS before receiving primary debulking surgery (PDS) or neoadjuvant treatment (NACT). The surgical and survival outcome were evaluated by univariate and multivariate analysis.
Among 300 consecutive patients submitted to S-LPS no complications related to the surgical procedure were registered. The laparoscopic evaluation showed that almost half of the patients (46.3%) had a high tumor load. One-hundred forty-eight (49.3%) women were considered suitable for PDS and the remaining 152 (50.7%) were submitted to NACT. The percentages of complete (residual tumor, RT=0) and optimal (RT<1cm) cytoreduction of PDS and interval debulking surgery (IDS) were 62.1% and 57.5%, 22.5% and 27.7%, respectively, p=0.07. The post-operative complications of NACT/IDS group were lower than PDS group (p=0.01). The median progression free survival in women with RT=0 at PDS was 25 months (95% CI, 15.1-34.8), which was statistically significant longer than in all other patients, irrespective of the type of treatment they received (p=0.0001). At multivariate analysis, residual disease (p=0.011) and performance status (p=0.016) maintained an independent association with the PFS.
Including S-LPS in a tertiary referral center for the management AEOC does not appear to have a negative impact in terms of survival and it may be helpful to individualize the treatment avoiding unnecessary laparotomies and surgical complications.
评估在原发性晚期上皮性卵巢癌（AEOC）患者中常规使用分期腹腔镜检查（S-LPS）的预后影响。
所有患者在接受原发性减瘤术（PDS）或新辅助治疗（NACT）前均接受 S-LPS。通过单因素和多因素分析评估手术和生存结果。
在 300 例连续接受 S-LPS 的患者中，未发现与手术过程相关的并发症。腹腔镜评估显示，近一半的患者（46.3%）肿瘤负荷较高。148 名（49.3%）妇女适合接受 PDS，其余 152 名（50.7%）接受 NACT。PDS 和间隔减瘤术（IDS）的完全（残留肿瘤，RT=0）和最佳（RT<1cm）肿瘤细胞减灭率的百分比分别为 62.1%和 57.5%、22.5%和 27.7%，p=0.07。NACT/IDS 组的术后并发症低于 PDS 组（p=0.01）。PDS 时 RT=0 的患者中位无进展生存期为 25 个月（95%CI，15.1-34.8），与其他所有患者相比，无论接受何种治疗，均具有统计学意义（p=0.0001）。多因素分析显示，残留疾病（p=0.011）和体能状态（p=0.016）与 PFS 具有独立相关性。
在三级转诊中心对 AEOC 进行管理时，包括 S-LPS 并不会对生存产生负面影响，并且可能有助于避免不必要的剖腹手术和手术并发症，从而实现个体化治疗。
