Eriksson Ane Gerda Z, Graul Ashley, Yu Miao C, Halko Anthony, Chi Dennis S, Zivanovic Oliver, Gardner Ginger J, Sonoda Yukio, Barakat Richard R, Abu-Rustum Nadeem R, Leitao Mario M
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medical College, New York, NY, USA.
Gynecol Oncol. 2017 Aug;146(2):263-267. doi: 10.1016/j.ygyno.2017.05.022. Epub 2017 May 17.
To assess the perioperative outcomes of minimal access surgery (MAS) in secondary surgical cytoreduction (SSCR) for recurrent epithelial ovarian cancer (ROC); to compare oncologic outcomes with laparotomy (LAP).
Using an institutional database, we identified all patients with ROC undergoing SSCR from 1/5/09-6/14/14. Selection for MAS or LAP was based on surgeon preference. To minimize selection bias, preoperative imaging was reviewed for all LAP cases. In this manner, we identified potential MAS candidates, who were used in the comparison. Intent-to-treat analyses were undertaken using statistical testing.
170 cases were identified (131 LAP, 8 LSC, 31 RBT). 68/131 (52%) LAP cases were deemed potential candidates for MAS. Feasibility analyses included 68 LAP and 39 MAS cases. Six (15%) MAS cases were converted to LAP. Median age, BMI, operative time did not differ significantly between the groups. Complete gross resection was achieved in 37/39 (95%) MAS, 63/68 (93%) LAP (P=1.0). Median estimated blood loss was 50cm (range, 5-500) MAS, 150cm (range, 0-1500) LAP (P=0.001). Median length of stay was 1day (range, 0-23) MAS, 5days (range, 1-21) LAP (P<0.001). Complications occurred in 3/39 (8%) MAS, 15/68 (22%) LAP (P=0.06). The 2-year progression-free survival was 56.1% (SE 9%) MAS, 63.5% (SE 6%) LAP (P=1.0). The 2-year overall survival was 92.2% (SE 5.4%) MAS, 81.4% (SE 5.5%) LAP (P=0.7).
MAS for SSCR is feasible in properly selected cases. MAS is associated with favorable perioperative outcomes and similar oncologic outcomes, compared to LAP.
评估在复发性上皮性卵巢癌（ROC）的二次手术细胞减灭术（SSCR）中，微创外科手术（MAS）的围手术期结局；并与开腹手术（LAP）的肿瘤学结局进行比较。
利用机构数据库，我们确定了2009年5月1日至2014年6月14日期间所有接受SSCR的ROC患者。MAS或LAP的选择基于外科医生的偏好。为尽量减少选择偏倚，对所有LAP病例的术前影像进行了复查。通过这种方式，我们确定了潜在的MAS候选者，并将其用于比较。采用统计检验进行意向性分析。
共确定170例病例（131例LAP、8例LSC、31例RBT）。131例LAP病例中有68例（52%）被认为是MAS的潜在候选者。可行性分析包括68例LAP和39例MAS病例。6例（15%）MAS病例转为LAP。两组间的中位年龄、体重指数、手术时间无显著差异。39例MAS中有37例（95%）实现了完全肉眼切除，68例LAP中有63例（93%）实现了完全肉眼切除（P = 1.0）。MAS的中位估计失血量为50cm³（范围5 - 500cm³），LAP为150cm³（范围0 - 1500cm³）（P = 0.001）。MAS的中位住院时间为1天（范围0 - 23天），LAP为5天（范围1 - 21天）（P < 0.001）。MAS组39例中有3例（8%）发生并发症，LAP组68例中有15例（22%）发生并发症（P = 0.06）。MAS组2年无进展生存率为56.1%（标准误9%），LAP组为63.5%（标准误6%）（P = 1.0）。MAS组2年总生存率为92.2%（标准误5.4%），LAP组为81.4%（标准误5.5%）（P = 0.7）。
对于经过适当选择的病例，MAS用于SSCR是可行的。与LAP相比，MAS具有良好的围手术期结局和相似的肿瘤学结局。
