Department of Gynecology and Obstetrics, University of Torino, Mauriziano Hospital, Largo Turati, 62, 10128 Torino, Italy.
Department of Gynecological Oncology, National Cancer Institute of Milan, Via Giacomo Venezian, 1, 20133 Milano, Italy.
Eur J Surg Oncol. 2014 Jul;40(7):891-8. doi: 10.1016/j.ejso.2013.11.026. Epub 2013 Dec 14.
Chemotherapy is the standard treatment of recurrent epithelial ovarian cancer (EOC), but its use in nodal relapses is still debated. On the other hand, the role of secondary cytoreductive surgery (SCS) remains controversial. Aim of this study is to evaluate feasibility and outcomes of SCS for the specific setting of recurrent ovarian cancer, exclusively relapsing in lymph nodes.
We conducted a retrospective analysis in five Italian Institutions (University of Torino, INT of Milano, CRO of Aviano, University of Pisa and INT of Napoli) from 2000 to 2012. Patients with EOC who underwent secondary surgery for isolated lymph node recurrence (ILNR) were selected.
Seventy-three patients were identified. At first diagnosis, patients received debulking surgery and platinum-based chemotherapy. The median disease free interval from completion of primary chemotherapy to nodal recurrence was 18 months. Nodal recurrence was para-aortic in 37 patients (50.7%), pelvic in 21 (28.8%), pelvic and para-aortic in 9 (12.3%), pelvic and inguinal in 3 (4.1%) and inguinal in 3 (4.1%). During SCS, in 1 patients nephrectomy was necessary for renal vein injury. No significant postoperative morbidity occurred. Median follow-up is 50 months. After secondary surgery, 32 (43.8%) are alive without disease, 18 (24.6%) are alive with disease and 23 patients (31.5%) are dead of disease. Five-year overall survival from the time of treatment of recurrent disease is 64%.
Secondary surgery for ILNR of ovarian cancer is feasible, safe, with low morbidity and it is associated with a favorable outcome.
化疗是复发性上皮性卵巢癌（EOC）的标准治疗方法，但在淋巴结复发中的应用仍存在争议。另一方面，二次细胞减灭术（SCS）的作用仍存在争议。本研究旨在评估 SCS 在复发性卵巢癌，仅淋巴结复发的特定情况下的可行性和结果。
我们对 2000 年至 2012 年意大利的五所机构（都灵大学、米兰 INT、阿维亚诺 CRO、比萨大学和那不勒斯 INT）进行了回顾性分析。选择了接受二次手术治疗孤立性淋巴结复发（ILNR）的 EOC 患者。
共确定了 73 例患者。在初次诊断时，患者接受了减瘤手术和铂类化疗。从完成原发性化疗到淋巴结复发的无疾病间隔中位数为 18 个月。37 例（50.7%）患者的淋巴结复发位于腹主动脉旁，21 例（28.8%）位于盆腔，9 例（12.3%）位于盆腔和腹主动脉旁，3 例（4.1%）位于盆腔和腹股沟，3 例（4.1%）位于腹股沟。在 SCS 期间，1 例患者因肾静脉损伤需要行肾切除术。无明显术后并发症。中位随访时间为 50 个月。在二次手术后，32 例（43.8%）无病生存，18 例（24.6%）有病生存，23 例（31.5%）死于疾病。从复发性疾病治疗开始的 5 年总生存率为 64%。
复发性卵巢癌 ILNR 的二次手术是可行的、安全的，且具有较低的发病率，并与有利的结果相关。
