Department of Gynaecological Oncology, Catherine Mc Auley Research Centre, University College Dublin School of Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland.
Department of Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland.
Ann Surg Oncol. 2021 Aug;28(8):4553-4560. doi: 10.1245/s10434-020-09494-3. Epub 2021 Jan 10.
Surgical resection remains the cornerstone of ovarian cancer management. In 2017, the authors implemented a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper gastrointestinal (GI) surgeons to increase gross macroscopic resection rates. This report aims to describe changes in complete cytoreduction rates and morbidity after the implementation of a multi-disciplinary surgical team comprising gynecologic oncologists as well as colorectal, hepatobiliary, and upper GI surgeons in a tertiary gynecologic oncology unit.
The study used two cohorts. Cohort A was a retrospectively collated cohort from 2006 to 2015. Cohort B was a prospectively collated cohort of patients initiated in 2017. A multidisciplinary approach to preoperative medical optimization, intraoperative management, and postoperative care was implemented in 2017. The patients in cohort B with upper abdominal disease were offered primary cytoreduction with or without hyperthermic intraperitoneal chemotherapy (HIPEC). Before 2017, the patients with upper abdominal disease received neoadjuvant chemotherapy (cohort A).
This study included 146 patients in cohort A (2006-2015) and 93 patients in cohort B (2017-2019) with stages 3 or 4 ovarian cancer. The overall complete macroscopic resection rate (CC0) increased from 58.9 in cohort A to 67.7% in cohort B. The rate of primary cytoreductive surgery (CRS) increased from 38 (55/146) in cohort A to 42% (39/93) in cohort B. The CC0 rate for the patients who underwent primary CRS increased from 49 in cohort A to 77% in cohort B. Major morbidity remained stable throughout both study periods (2006-2019).
The study data demonstrate that implementation of a multidisciplinary team intraoperative approach and a meticulous approach to preoperative optimization resulted in significantly improved complete resection rates, particularly for women offered primary CRS.
手术切除仍然是卵巢癌管理的基石。2017 年，作者实施了一个多学科手术团队，由妇科肿瘤学家以及结直肠、肝胆和上胃肠道（GI）外科医生组成，以提高大体宏观切除率。本报告旨在描述在妇科肿瘤学三级单位中实施由妇科肿瘤学家以及结直肠、肝胆和上胃肠道外科医生组成的多学科手术团队后，完全减瘤率和发病率的变化。
该研究使用了两个队列。队列 A 是 2006 年至 2015 年回顾性收集的队列。队列 B 是 2017 年开始前瞻性收集的患者队列。2017 年实施了术前医疗优化、术中管理和术后护理的多学科方法。有上腹部疾病的队列 B 患者提供了初始减瘤术，有或没有腹腔内热灌注化疗（HIPEC）。在 2017 年之前，队列 A 中患有上腹部疾病的患者接受了新辅助化疗。
该研究包括队列 A（2006-2015 年）的 146 例患者和队列 B（2017-2019 年）的 93 例患有 3 或 4 期卵巢癌的患者。总体完全宏观切除率（CC0）从队列 A 的 58.9%增加到队列 B 的 67.7%。初始减瘤术（CRS）的比例从队列 A 的 38（146/55）增加到队列 B 的 42%（93/39）。队列 A 中接受初始 CRS 的患者的 CC0 率从 49%增加到队列 B 的 77%。主要发病率在两个研究期间均保持稳定（2006-2019 年）。
研究数据表明，实施多学科团队手术方法和术前优化的细致方法显著提高了完全切除率，特别是对接受初始 CRS 的女性。
