Department of Gynecologic Oncology, Metaxa Cancer Hospital, Mpotasi 51, 18537, Piraeus, Greece.
J Robot Surg. 2021 Apr;15(2):155-163. doi: 10.1007/s11701-020-01155-7. Epub 2020 Oct 9.
We evaluated the effectiveness, safety and efficacy of robotic interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) treated with neoadjuvant chemotherapy (NACT). We conducted a systematic review of the published relevant studies. Α total of 102 patients were evaluated. Mean operative time ranged from 164 to 312 min (mean ± SD: 246 ± 61 min) while mean estimated blood loss ranged from 106.9 to 262.5 ml (mean ± SD: 168 ± 68 ml) and postoperative blood transfusion rate was 19% (n = 19/98). Complete cytoreduction rate (R0 resection) was achieved in 75 patients (76.5%), whereas residual disease ≤ 1 cm in 21 women (21.5%). Mean hospital stay was 2.4 days. No intraoperative and six postoperative (14.6%) complications were reported. Laparotomy conversion rate was 9.2% (9/98) mostly in the terms of achieving complete cytoreduction and 30-day mortality rate was 9.2% (n = 9/98). The median overall survival varied from 39.7 to 47.2 months, while the progression-free survival ranged from 20.6 to 21.2 months during a median follow-up period from 2 to 86 months (median 25.3 months). A total of 60 women (61%) developed disease recurrence. One of the studies reported significantly improved OS and PFS in patients who underwent robotic IDS when compared to those who had laparotomy either during or before the addition of robotic surgery in the management of advanced ovarian cancer disease (47.2 vs 37.8 vs 37.9, p = 0.004 for OS and 20.6 vs 13.9 vs 11.9, p = 0.005 for PFS, respectively). The same was also observed when controlling the parameters of age and stage for patients in the robotic arm (p = 0.02). Robotic interval debulking surgery can be considered in the management of advanced ovarian cancer patients after receiving neoadjuvant chemotherapy. Larger meta-analyses including multicenter randomized control trials are necessary to specify the exact profile of the patients that could benefit from this treatment strategy.
我们评估了机器人间隔减瘤手术（IDS）在接受新辅助化疗（NACT）治疗的晚期上皮性卵巢癌（EOC）患者中的有效性、安全性和疗效。我们对已发表的相关研究进行了系统评价。共评估了 102 名患者。手术时间平均为 164 至 312 分钟（平均±标准差：246±61 分钟），估计失血量平均为 106.9 至 262.5 毫升（平均±标准差：168±68 毫升），术后输血率为 19%（n=19/98）。75 名患者（76.5%）达到完全肿瘤减灭术（R0 切除），21 名患者（21.5%）残留肿瘤≤1 厘米。平均住院时间为 2.4 天。无术中并发症，术后（14.6%）有 6 例并发症。剖腹术转化率为 9.2%（9/98），主要是为了实现完全肿瘤减灭术，30 天死亡率为 9.2%（n=9/98）。中位总生存期从 39.7 至 47.2 个月不等，中位随访时间从 2 至 86 个月（中位 25.3 个月）期间，无进展生存期从 20.6 至 21.2 个月不等。共有 60 名女性（61%）发生疾病复发。一项研究报告称，与接受剖腹术的患者相比，接受机器人 IDS 的患者的总生存期和无进展生存期显著改善，无论是在添加机器人手术期间还是在此之前，都可用于治疗晚期卵巢癌疾病（OS 为 47.2 比 37.8 比 37.9，p=0.004；PFS 为 20.6 比 13.9 比 11.9，p=0.005）。当控制机器人组患者的年龄和分期参数时，也观察到了同样的结果（p=0.02）。机器人间隔减瘤术可考虑用于接受新辅助化疗的晚期卵巢癌患者的治疗。需要更大的荟萃分析，包括多中心随机对照试验，以确定哪些患者可能从这种治疗策略中受益。
