Escobar Pedro F, Levinson Kimberly L, Magrina Javier, Martino Martin A, Barakat Richard R, Fader Amanda N, Leitao Mario M
Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA; Division of Gynecologic Oncology, HIMA-San Pablo, Caguas, PR, USA.
Division of Gynecologic Oncology, Cleveland Clinic, Cleveland, OH, USA.
Gynecol Oncol. 2014 Aug;134(2):253-6. doi: 10.1016/j.ygyno.2014.05.007. Epub 2014 May 16.
Minimally invasive surgery for recurrent ovarian cancer is generally not performed. The aim of this study was to assess the feasibility and surgical outcomes of robotic-assisted surgery in the management of recurrent ovarian cancer.
Eligible patients included those with confirmed recurrent ovarian cancer amenable to surgical resection and in which a complete resection was thought to be feasible with the use of the robotic platform. Patients with evidence of carcinomatosis were not considered for a robotic approach. Clinical and pathologic data were abstracted from the medical records. Appropriate statistical tests were performed using SPSS statistical software program (SPSS 20.0 Inc., Chicago, IL).
A total of 48 patients were identified. Thirty-six (75%) patients had a recurrent mass or masses isolated to one anatomic region (pelvis or abdomen). Conversion to laparotomy was necessary in 4 (8.3%) cases. In cases not requiring conversion to laparotomy, the median operative time, EBL, and length of stay were 179.5 min, 50 cc, and 1 day, respectively. An optimal debulking was achieved in 36 (82%) cases. Complications occurred in 6 (13.6%) cases. The median operative time, EBL, length of stay, and complications were all statistically significantly lower in the cases not converted to laparotomy compared to those that were (p<0.001).
This study suggests that select patients with recurrent ovarian cancer in the absence of carcinomatosis may be candidates for secondary surgical cytoreduction via a robotic approach. Surgical and postoperative outcomes appear to be favorable compared to reports of laparotomy in recurrent ovarian cancer.
复发性卵巢癌一般不进行微创手术。本研究旨在评估机器人辅助手术治疗复发性卵巢癌的可行性及手术效果。
符合条件的患者包括经确诊的复发性卵巢癌患者，这些患者适合手术切除，且认为使用机器人平台可行完整切除。有癌性腹膜炎证据的患者不考虑采用机器人手术方法。从病历中提取临床和病理数据。使用SPSS统计软件程序（SPSS 20.0 Inc.，伊利诺伊州芝加哥）进行适当的统计检验。
共确定了48例患者。36例（75%）患者有孤立于一个解剖区域（盆腔或腹部）的复发性肿块。4例（8.3%）病例需要转为开腹手术。在不需要转为开腹手术的病例中，中位手术时间、估计失血量和住院时间分别为179.5分钟、50毫升和1天。36例（82%）病例实现了最佳减瘤。6例（13.6%）病例发生并发症。与转为开腹手术的病例相比，未转为开腹手术的病例中位手术时间、估计失血量、住院时间和并发症在统计学上均显著更低（p<0.001）。
本研究表明，部分无癌性腹膜炎的复发性卵巢癌患者可能适合通过机器人手术进行二次手术细胞减灭术。与复发性卵巢癌开腹手术的报道相比，手术及术后效果似乎较好。
