Ferron G, Narducci F, Pouget N, Touboul C
Inserm CRCT 19, département de chirurgie oncologique, institut Claudius Regaud, institut universitaire du cancer, 31000 Toulouse, France.
Inserm U1192, département de chirurgie oncologique, centre Oscar Lambret, 59000 Lille, France.
Gynecol Obstet Fertil Senol. 2019 Feb;47(2):197-213. doi: 10.1016/j.gofs.2019.01.003. Epub 2019 Feb 19.
Debulking surgery is the key step of advanced stage ovarian cancer treatment with chemotherapy. The quality of surgical resection is the main prognosis factor, thus a complete resection must be achieved (grade A) in an expert center (grade B). Surgery for stage IV is possible and has a benefit in case of complete peritoneal resection (LoE3). Pelvic and aortic lymphadenectomies are recommended in case of clinical or radiological suspicious lymph nodes (grade B). In absence of clinical or radiological suspicious lymph nodes and in case of complete peritoneal resection during initial debulking surgery, lymphadenectomy can be omitted because it won't change nor medical treatment nor overall survival (grade B). Neoadjuvant chemotherapy can be proposed in case of: impossibility to perform initial complete surgical resection (grade B) ; alteration of general state or co-morbidities or elderly patient (in order to decrease morbidity and increase quality of life) (grade B); stage IV with multiple intra-hepatic or pulmonary metastasis or important ascites with miliary (grade B). In case of stage III or IV ovarian cancer diagnosed on a biopsy during prior laparotomy, a neoadjuvant chemotherapy and interval debulking surgery should be preferred (gradeC). In case of palliative surgery or peroperative impossibility to perform a complete resection, no data regarding the type of surgery to perform influencing survival or quality of life is available. Peritoneal carcinosis description before resection and residual disease at the end of the surgery should be reported (size, location and reason of non-extirpability) (grade B). A score of peritoneal carcinosis such as Peritoneal Carcinosis Index (PCI) should be used in order to objectively evaluate the tumoral burden (gradeC). A standardized operative report is recommended (gradeC).
肿瘤细胞减灭术是晚期卵巢癌化疗治疗的关键步骤。手术切除质量是主要的预后因素，因此必须在专家中心（B级）实现完全切除（A级）。IV期手术是可行的，在完全腹膜切除的情况下有益（证据水平3）。如果临床或影像学检查怀疑有淋巴结转移，建议进行盆腔和主动脉旁淋巴结清扫术（B级）。如果没有临床或影像学检查怀疑有淋巴结转移，且在初次肿瘤细胞减灭术中进行了完全腹膜切除，则可以省略淋巴结清扫术，因为这不会改变治疗方案或总生存期（B级）。在以下情况下可考虑新辅助化疗：无法进行初次完全手术切除（B级）；一般状况改变、有合并症或老年患者（为了降低发病率和提高生活质量）（B级）；IV期伴有多发肝内或肺转移或大量粟粒性腹水（B级）。如果在先前剖腹手术的活检中诊断为III期或IV期卵巢癌，应优先选择新辅助化疗和间隔性肿瘤细胞减灭术（C级）。如果进行姑息性手术或术中无法进行完全切除，则没有关于何种手术类型会影响生存或生活质量的数据。应报告切除前的腹膜转移情况和手术结束时的残留病灶（大小、位置和无法切除的原因）（B级）。应使用腹膜转移评分，如腹膜转移指数（PCI），以客观评估肿瘤负荷（C级）。建议采用标准化的手术报告（C级）。
