Department of Woman and Child Health, Woman Health Area, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
Department of Woman and Child Health, Woman Health Area, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy.
J Minim Invasive Gynecol. 2018 Jul-Aug;25(5):848-854. doi: 10.1016/j.jmig.2017.12.023. Epub 2018 Jan 8.
To describe the potential role of intraoperative ultrasound (IOUS) in the detection and localization of recurrent disease in gynecologic cancer patients during minimally invasive surgery (MIS).
A prospective cohort study (Canadian Task Force classification II-1).
A university hospital.
Fifty-one gynecologic cancer patients with isolated recurrent disease.
IOUS during secondary cytoreductive surgery (SCS) by MIS.
From November 2015 to February 2017 51 gynecologic cancer patients with isolated recurrent disease and candidates for SCS were treated by MIS. Recurrent tumor was preoperatively assessed at clinical examination, transvaginal and transabdominal sonography, and radiologic evaluation in all women. Twelve of 51 women (23.5%) needed IOUS. Type of disease was ovarian in 5 women (42%), endometrial in 4 (33%), cervical in 1 (8%), vaginal cancer in 1 (8%), and uterine sarcoma in 1 (8%). Recurrence was localized deep in the pelvis in 7 cases (58%), lymph nodes in 3 (25%), and extraperitoneal in 2 cases (17%). Recurrence was dimmed in the surgical field, due to either presence of adherences, deep anatomic position, small size, and/or lack of tactile feeling. IOUS was able to identify the lesions in all women, allowing MIS (83% laparoscopy and 17% robotic) complete cytoreduction, with no conversion to laparotomy. Median operative time was 150 minutes (range, 77-280). No intraoperative/postoperative complications occurred. Histologic examination confirmed the presence of recurrence in 11 of 12 cases (92%), whereas the remaining case showed inflammatory tissue. With a median follow-up time of 15 months (range, 6-19), all patients except 2 were still alive.
About 1 of 4 patients (25%) with single gynecologic cancer recurrence needs IOUS to benefit from MIS for complete secondary cytoreduction.
描述术中超声（IOUS）在妇科癌症患者微创外科（MIS）中检测和定位复发性疾病的潜在作用。
前瞻性队列研究（加拿大任务组分类 II-1）。
一家大学医院。
51 例妇科癌症患者，孤立性复发性疾病。
MIS 下二次细胞减灭术（SCS）中的 IOUS。
2015 年 11 月至 2017 年 2 月，51 例妇科癌症患者，孤立性复发性疾病且为 SCS 候选者，接受了 MIS 治疗。51 例女性均在术前通过临床检查、经阴道和经腹超声、以及放射学评估对复发性肿瘤进行了评估。12 例（23.5%）需要 IOUS。5 例（42%）为卵巢癌，4 例（33%）为子宫内膜癌，1 例（8%）为宫颈癌，1 例（8%）为阴道癌，1 例（8%）为子宫肉瘤。7 例（58%）的复发位于骨盆深部，3 例（25%）位于淋巴结，2 例（17%）位于腹膜外。由于存在粘连、深部解剖位置、体积小和/或缺乏触觉，手术野中的复发肿瘤模糊不清。IOUS 能够识别所有女性的病变，允许 MIS（83%腹腔镜，17%机器人）完全细胞减灭，无剖腹术转为。中位手术时间为 150 分钟（范围，77-280）。无术中/术后并发症发生。组织学检查证实 12 例（92%）中的 11 例存在复发，而其余 1 例显示炎症组织。中位随访时间为 15 个月（范围，6-19），除 2 例外，所有患者均存活。
约 1 例（25%）的妇科癌症复发性患者需要 IOUS 才能从 MIS 中受益，以进行完全的二次细胞减灭术。
