Fagotti Anna, Perelli Federica, Pedone Luigi, Scambia Giovanni
Gynecologic Oncology, S. Maria Hospital, University of Perugia, Terni, Italy.
Obstetrics and Gynecology, Careggi Hospital, University of Florence, Florence, Italy.
Curr Treat Options Oncol. 2016 Jan;17(1):3. doi: 10.1007/s11864-015-0379-8.
Minimally invasive surgery (MIS) currently is performed to stage and treat ovarian cancer at different stages of disease; however, the higher level of evidence from existing studies is IIB. Despite the absence of randomized controlled trials, MIS represents a safe and adequate procedure for treating and staging early ovarian cancer, and its use has increased significantly in clinical practice. Major concerns are related to minimizing tumor disruption or dissemination, removing the adnexal mass intact, adequate retroperitoneal staging, and fertility-sparing surgery for young patients. The main goal for patients with advanced ovarian cancer is to determine the best therapeutic strategy by evaluating the risks and benefits of primary debulking surgery versus neoadjuvant chemotherapy followed by interval debulking surgery. The use of staging laparoscopy in patients with advanced epithelial ovarian cancer appears to be the most researched and accepted approach. Regarding other types and stages of ovarian cancer, although the evidence is very promising, clinical trials performed by expert gynecologic oncology surgeons in referral centers are still needed to prove the efficacy of such an approach in these patients. In particular, MIS has provided an opportunity to remove localized recurrences, with both retroperitoneal and intraperitoneal diffusion.
目前，微创手术（MIS）用于对不同疾病阶段的卵巢癌进行分期和治疗；然而，现有研究的较高证据水平为IIB级。尽管缺乏随机对照试验，但MIS是治疗和分期早期卵巢癌的一种安全且充分的方法，并且其在临床实践中的应用显著增加。主要关注点包括尽量减少肿瘤破裂或播散、完整切除附件肿块、进行充分的腹膜后分期以及为年轻患者实施保留生育功能的手术。晚期卵巢癌患者的主要目标是通过评估初次肿瘤细胞减灭术与新辅助化疗后行间隔性肿瘤细胞减灭术的风险和益处来确定最佳治疗策略。对于晚期上皮性卵巢癌患者，使用分期腹腔镜检查似乎是研究最多且最被接受的方法。对于其他类型和阶段的卵巢癌，尽管证据很有前景，但仍需要在转诊中心由专业妇科肿瘤外科医生进行临床试验，以证明这种方法在这些患者中的疗效。特别是，MIS为切除伴有腹膜后和腹腔内扩散的局部复发病灶提供了机会。
