Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, New York.
J Minim Invasive Gynecol. 2019 Mar-Apr;26(3):471-476. doi: 10.1016/j.jmig.2018.05.021. Epub 2018 Jun 9.
Evaluate the prevalence, trends, and outcomes of minimally invasive surgical (MIS) staging of malignant ovarian germ cell tumors (MOGCTs) apparently confined to the ovary.
Retrospective cohort study (Canadian Task Force classification II-2).
Participating hospitals in the National Cancer Data Base.
Women diagnosed between 2010 and 2014 with a MOGCT apparently confined to the ovary with information on the planned surgical approach.
Staging with MIS or laparotomy.
A total of 918 patients were identified. MIS was planned for 294 patients (32%): a laparoscopic approach for 237 patients and a robotic-assisted approach for 57 patients. Rate of conversion to laparotomy was 11% (46 cases), 1.7% and 15.6% in the robotic and laparoscopy groups, respectively (p = .003). No difference in the use of MIS was noted based on year of diagnosis (p = .38). By multivariate analysis white race, higher level of education, and smaller tumor size were associated with the receipt of MIS. Patients in the MIS group were less likely to undergo lymph node dissection (39.6% vs 51.3%, p = .001) and omentectomy (18.7% vs 28.5%, p = .002). Hospital stay after surgery was shorter for patients who had MIS (median, 2 vs 3 days; p <.001). Unplanned 30-day readmission rate was also lower in the MIS group (1.4% vs 3.9%, p = .043). No difference in overall survival was noted between the 2 groups (p = .81).
MIS for apparent early-stage MOGCTs was less comprehensive but associated with a decreased hospital stay and unplanned readmission rate.
评估微创外科（MIS）对明显局限于卵巢的恶性卵巢生殖细胞肿瘤（MOGCT）分期的流行率、趋势和结果。
回顾性队列研究（加拿大任务组分类 II-2）。
国家癌症数据库参与医院。
2010 年至 2014 年间诊断为明显局限于卵巢的 MOGCT 且有计划手术方法信息的女性。
MIS 或剖腹术分期。
共确定了 918 名患者。294 名患者计划进行 MIS（32%）：237 名患者采用腹腔镜方法，57 名患者采用机器人辅助方法。中转开腹率为 11%（46 例），机器人组和腹腔镜组分别为 1.7%和 15.6%（p=0.003）。根据诊断年份，MIS 的使用无差异（p=0.38）。多变量分析显示，白色人种、较高的教育水平和较小的肿瘤大小与接受 MIS 相关。MIS 组患者淋巴结清扫术（39.6%比 51.3%，p=0.001）和网膜切除术（18.7%比 28.5%，p=0.002）的可能性较小。接受 MIS 的患者术后住院时间较短（中位数为 2 天比 3 天；p<0.001）。MIS 组计划外 30 天再入院率也较低（1.4%比 3.9%，p=0.043）。两组总体生存率无差异（p=0.81）。
对于明显早期 MOGCT，MIS 不够全面，但与缩短住院时间和降低计划外再入院率相关。
