Ang Christine, Bryant Andrew, Barton Desmond P J, Pomel Christophe, Naik Raj
Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Sheriff Hill, Gateshead, UK, NE9 6SX.
Cochrane Database Syst Rev. 2014 Feb 4;2014(2):CD010449. doi: 10.1002/14651858.CD010449.pub2.
Cancer is a leading cause of death worldwide. Gynaecological cancers (i.e. cancers affecting the ovaries, uterus, cervix, vulva and vagina) are among the most common cancers in women. Unfortunately, given the nature of the disease, cancer can recur or progress in some patients. Although the management of early-stage cancers is relatively straightforward, with lower associated morbidity and mortality, the surgical management of advanced and recurrent cancers (including persistent or progressive cancers) is significantly more complicated, often requiring very extensive procedures. Pelvic exenterative surgery involves removal of some or all of the pelvic organs. Exenterative surgery for persistent or recurrent cancer after initial treatment is difficult and is usually associated with significant perioperative morbidity and mortality. However, it provides women with a chance of cure that otherwise may not be possible. In carefully selected patients, it may also have a place in palliation of symptoms. The biology of recurrent ovarian cancer differs from that of other gynaecological cancers; it is often responsive to chemotherapy and is not included in this review.
To evaluate the effectiveness and safety of exenterative surgery versus other treatment modalities for women with recurrent gynaecological cancer, excluding recurrent ovarian cancer (this is covered in a separate review).
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE up to February 2013. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of clinical guidelines and review articles and contacted experts in the field.
Randomised controlled trials (RCTs) or non-randomised studies with concurrent comparison groups that included multivariate analyses of exenterative surgery versus medical management in women with recurrent gynaecological malignancies.
Two review authors independently assessed whether potentially relevant studies met the inclusion criteria. No studies were found; therefore no data were analysed.
The search strategy identified 1311 unique references, of which seven were retrieved in full, as they appeared to be potentially relevant on the basis of title and abstract. However, all were excluded, as they did not meet the inclusion criteria of the review.
AUTHORS' CONCLUSIONS: We found no evidence to inform decisions about exenterative surgery for women with recurrent cervical, endometrial, vaginal or vulvar malignancies. Ideally, a large RCT or, at the very least, well-designed non-randomised studies that use multivariate analysis to adjust for baseline imbalances are needed to compare exenterative surgery versus medical management, including palliative care.
癌症是全球主要的死亡原因之一。妇科癌症（即影响卵巢、子宫、宫颈、外阴和阴道的癌症）是女性中最常见的癌症类型。不幸的是，鉴于该疾病的性质，一些患者的癌症可能会复发或进展。虽然早期癌症的治疗相对简单，相关的发病率和死亡率较低，但晚期和复发性癌症（包括持续性或进展性癌症）的手术治疗要复杂得多，通常需要非常广泛的手术操作。盆腔脏器清除术涉及切除部分或全部盆腔器官。对初始治疗后持续性或复发性癌症进行脏器清除术很困难，且通常与显著的围手术期发病率和死亡率相关。然而，它为女性提供了治愈的机会，否则可能无法实现。在经过精心挑选的患者中，它在缓解症状方面也可能有一席之地。复发性卵巢癌的生物学特性与其他妇科癌症不同；它通常对化疗有反应，本综述不包括此类癌症。
评估脏器清除术与其他治疗方式相比，对复发性妇科癌症（不包括复发性卵巢癌，复发性卵巢癌在另一篇综述中涵盖）女性患者的有效性和安全性。
我们检索了截至2013年2月的Cochrane对照试验中心注册库（CENTRAL）、MEDLINE和EMBASE。我们还检索了临床试验注册库、科学会议摘要以及临床指南和综述文章的参考文献列表，并联系了该领域的专家。
随机对照试验（RCT）或具有同期比较组的非随机研究，其中包括对复发性妇科恶性肿瘤女性患者进行脏器清除术与药物治疗的多变量分析。
两位综述作者独立评估潜在相关研究是否符合纳入标准。未找到相关研究；因此未进行数据分析。
检索策略共识别出1311篇独特的参考文献，其中7篇全文被检索到，因为根据标题和摘要它们似乎可能相关。然而，所有这些文献均被排除，因为它们不符合本综述的纳入标准。
我们没有找到证据来为复发性宫颈癌、子宫内膜癌、阴道癌或外阴癌女性患者的脏器清除术决策提供参考。理想情况下，需要进行一项大型随机对照试验，或者至少进行设计良好的非随机研究，并使用多变量分析来调整基线不平衡，以比较脏器清除术与包括姑息治疗在内的药物治疗。
