Tozzi Roberto, Hardern Kieran, Gubbala Kumar, Garruto Campanile Riccardo, Soleymani Majd Hooman
Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
Gynecol Oncol. 2017 Mar;144(3):564-570. doi: 10.1016/j.ygyno.2016.12.019. Epub 2017 Jan 7.
In this study we describe the technique of the En-bloc resection of the pelvis (EnBRP) in 10 standardised and reproducible steps, whereby all pelvic organs, except the bladder, are removed together with the peritoneum. In addition, we compare the surgical and survival outcomes of patients who underwent upfront vs. interval surgery.
Retrospective analysis of patients with FIGO Stage IIIC-IV ovarian cancer treated with Visceral Peritoneal Debulking (VPD) who had EnBRP. The study population was divided into Group 1 (up-front VPD) and group 2 (VPD after neo-adjuvant chemotherapy). The aim was to assess the incidence of EnBRP. We also assessed rate of complete resection (CR), procedure-specific and overall morbidity, disease free and overall survival. Results were compared between group 1 and 2.
Overall 92 out of 200 patients (46%) needed an EnBRP during the VPD. Forty-eight patients were in Group 1 and 44 patients in Group 2. CR was achieved in all patients. No intra-operative procedure specific morbidity was recorded. Dehiscence of bowel anastomosis was the only procedure specific morbidity. Rate was 2%, with 1 episode recorded in each group. Both patients were managed and settled with formation of a bowel diversion. The overall morbidity rate was 33%, 35% in group 1 and 31% in group 2. The mortality rate was 1%. Median disease free survival was 20months, 25 in group 1 vs. 15 in group 2 (P=0.009).
EnBRP is a safe and effective technique to tackle the pelvic disease of patients with advanced ovarian cancer. The reduced blood loss, the high rate of clear margins and CR of the disease are accompanied by a low rate of surgical morbidity. These features are particularly suitable for patients who are due to start or re-start chemotherapy. The standardization of the technique will make it more reproducible and easier to be taught. In addition, it will facilitate comparison of results and the inclusion of this technique in the portfolio of procedures as part of debulking surgery.
在本研究中，我们将整块切除骨盆（EnBRP）技术描述为10个标准化且可重复的步骤，通过该技术，除膀胱外的所有盆腔器官均与腹膜一起被切除。此外，我们比较了接受 upfront手术与间隔手术的患者的手术和生存结果。
对接受内脏腹膜减瘤术（VPD）并行EnBRP的国际妇产科联盟（FIGO）IIIC-IV期卵巢癌患者进行回顾性分析。研究人群分为第1组（ upfront VPD）和第2组（新辅助化疗后行VPD）。目的是评估EnBRP的发生率。我们还评估了完全切除率（CR）、特定手术和总体发病率、无病生存率和总生存率。比较第1组和第2组的结果。
200例患者中共有92例（46%）在VPD期间需要进行EnBRP。第1组有48例患者，第2组有44例患者。所有患者均实现了CR。未记录到术中特定手术的发病率。肠吻合口裂开是唯一的特定手术发病率。发生率为2%，每组各记录1例。两名患者均通过形成肠造口术得到处理并康复。总体发病率为33%，第1组为35%，第2组为31%。死亡率为1%。无病生存期的中位数为20个月，第1组为25个月，第2组为15个月（P=0.009）。
EnBRP是一种安全有效的技术，可用于治疗晚期卵巢癌患者的盆腔疾病。减少的失血量、高切缘阳性率和疾病CR率伴随着较低的手术发病率。这些特点特别适合即将开始或重新开始化疗的患者。该技术的标准化将使其更具可重复性且更易于传授。此外，它将便于结果的比较，并将该技术纳入减瘤手术程序组合中。
