Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
Department of Gynaecologic Oncology, Oxford University Hospital, Oxford UK.
Gynecol Oncol. 2015 Aug;138(2):252-8. doi: 10.1016/j.ygyno.2015.05.010. Epub 2015 May 21.
To measure the efficacy and the safety of Visceral-Peritoneal Debulking (VPD) in patients with stage IIIC-IV ovarian cancer and to compare the outcomes before and after chemotherapy.
Between 2008 and 2013, 200 consecutive patients were offered VPD for stage IIIC/IV ovarian cancer. Exclusion criteria were: metastases in the lungs or 3 liver segments at CT review and/or disease on small bowel serosa or encasing the porta hepatis at explorative laparoscopy. The endpoints were efficacy (rate of complete resection, CR) and safety (morbidity and mortality). The results were compared between patients in group 1 (upfront surgery) and group 2 (during or after chemotherapy).
Ninety-eight patients were in group 1 and 102 in group 2. Twenty out of 200 patients (10%) did not have VPD, 180 out of 200 patients (90%) had VPD and CR: 90.8% in group 1, 89.8% in group 2. The mortality (1%) and intra-operative complication rate (3.3%) were similar. Post-operative complications rate was 34.8% in group 1 vs. 30.7% in group 2 (P=0.669). The difference in grade III (15.7% vs. 5.5%, P=0.053) and grade IIIb complications (13.4% vs. 4.4%, P=0.062) approached statistical significance. All other outcomes were not significantly different in the 2 groups.
VPD achieved CR in 90% of the patients. Neo-adjuvant chemotherapy did not increase the rate of CR and did not significantly decrease the morbidity or the complexity of the surgery.
测量在 IIIC-IV 期卵巢癌患者中进行内脏腹膜减瘤术（VPD）的疗效和安全性，并比较化疗前后的结果。
2008 年至 2013 年间，200 名连续患者因 IIIC/IV 期卵巢癌接受 VPD。排除标准为：CT 复查时肺部或 3 个肝段转移和/或腹腔镜探查时小肠浆膜或肝门包绕的疾病。终点是疗效（完全切除率，CR）和安全性（发病率和死亡率）。将患者分为 1 组（手术前）和 2 组（化疗期间或之后），比较两组的结果。
200 名患者中 98 名在组 1，102 名在组 2。200 名患者中有 20 名（10%）未进行 VPD，200 名患者中有 180 名（90%）进行了 VPD 和 CR：组 1为 90.8%，组 2为 89.8%。死亡率（1%）和术中并发症发生率（3.3%）相似。组 1术后并发症发生率为 34.8%，组 2为 30.7%（P=0.669）。III 级（15.7%对 5.5%，P=0.053）和 IIIb 级并发症（13.4%对 4.4%，P=0.062）的差异有统计学意义。两组的其他结果均无显著差异。
VPD 使 90%的患者获得 CR。新辅助化疗并未增加 CR 率，也未显著降低发病率或手术的复杂性。
