Di Guilmi Julián, Salvo Gloria, Mehran Reza, Sood Anil K, Coleman Robert L, Lu Karen H, Vaporciyan Ara, Ramirez Pedro T
*Department of Gynecology, Hospital Británico de Buenos Aires, Buenos Aires, Argentina; †Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; and ‡Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Int J Gynecol Cancer. 2016 May;26(4):801-6. doi: 10.1097/IGC.0000000000000680.
Tools that accurately predict the presence of metastatic ovarian cancer in the pleura are limited. Thus, we sought to summarize the current literature on video-assisted thoracoscopic surgery (VATS) and its applicability in patients with advanced ovarian cancer. A total of 187 patients with suspected ovarian cancer who underwent the VATS procedure were identified for this analysis. The median patient age was 59.4 years (range, 20.3-83 years). The median operative time for VATS was 32 minutes (range, 5-65 minutes). In 89 patients (48%), VATS revealed macroscopic disease in the pleural cavity. After VATS, 44 patients underwent neoadjuvant chemotherapy, and the remaining 143 patients underwent primary cytoreductive surgery. Video-assisted thoracoscopic surgery led to a change in disease stage or management in 76 patients (41%). Among patients with pleural effusions, VATS revealed pleural disease in 57% of patients, and 73% of patients with positive pleural cytology had evidence of pleural disease at the time of VATS. In addition, 23.5% of patients with negative pleural cytology had evidence of pleural disease at the time of VATS. Prospective trials are needed to accurately evaluate the impact of VATS on disease-free and overall survival in patients with advanced ovarian cancer. Video-assisted thoracoscopic surgery can help determine which patients are ideal candidates for surgical cytoreduction.
准确预测胸膜转移性卵巢癌存在的工具有限。因此，我们试图总结当前关于电视辅助胸腔镜手术（VATS）及其在晚期卵巢癌患者中的适用性的文献。本分析共纳入了187例接受VATS手术的疑似卵巢癌患者。患者的中位年龄为59.4岁（范围20.3 - 83岁）。VATS的中位手术时间为32分钟（范围5 - 65分钟）。89例患者（48%）的VATS显示胸腔内有肉眼可见的病变。VATS术后，44例患者接受了新辅助化疗，其余143例患者接受了初次细胞减灭术。电视辅助胸腔镜手术使76例患者（41%）的疾病分期或治疗方案发生了改变。在胸腔积液患者中，VATS在57%的患者中发现了胸膜病变，73%胸腔细胞学检查阳性的患者在VATS时存在胸膜病变证据。此外，23.5%胸腔细胞学检查阴性的患者在VATS时存在胸膜病变证据。需要进行前瞻性试验来准确评估VATS对晚期卵巢癌患者无病生存期和总生存期的影响。电视辅助胸腔镜手术有助于确定哪些患者是手术细胞减灭术的理想候选人。
