Achen G, Koual M, Bentivegna E, Fournier L, Nguyen Xuan H-T, Delanoy N, Bats A-S, Azaïs H
Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou, AP-HP.CUP, Paris, France; Faculté de médecine Paris Centre, université de Paris, Paris, France.
Service de chirurgie cancérologique gynécologique et du sein, hôpital européen Georges-Pompidou, AP-HP.CUP, Paris, France; Faculté de médecine Paris Centre, université de Paris, Paris, France; Inserm UMR-S 1124, centre universitaire des Saints Pères, université de Paris, Paris, France.
Gynecol Obstet Fertil Senol. 2021 Oct;49(10):736-743. doi: 10.1016/j.gofs.2021.02.006. Epub 2021 Feb 23.
Advanced epithelial ovarian cancer (EOC) is associated with high mortality and often managed first with neoadjuvant chemotherapy (NACT) followed by debulking surgery. Laparoscopic surgery with or without robotic assistance (Minimally Invasive Surgery (MIS)) may represent a beneficial option for these patients. The objective of this literature review is to clarify the place of MIS in the management of advanced EOC for selected patients.
Pubmed, Cochrane and Clinicaltrials.gov online databases were used for this review, to select English or French published articles.
We selected 11 original articles published between 2015 and 2020, 6 of which compared MIS and laparotomy. Among these 11 studies, 8 were retrospective cohorts, 2 were phase II trials, and one was a case-control study. In total, there were 3721 patients, of which 854 (23%) were treated with MIS. The robotic assistance was used with 224 patients (26%) of those MIS patients. Looking specifically at MIS patients, the laparoconversion rate was 9.5%, the rate of complete resection (CC-0) was 83.4%. Finally, the MIS complication rate was 1% intraoperatively and 12% postoperatively. The rate of complete resection, postoperative complication, as well as overall survival (OS) were comparable between patients treated with MIS or laparotomy. One study found an improved disease-free survival (DFS) in MIS versus laparotomy (18 months versus 12 months; P=0.027).
MIS seems feasible, effective, and reliable in comparison to laparotomy for the completion of cytoreductive surgery after NACT without compromising oncological safety. Prospective randomized controlled trials are needed to confirm the role of MIS in advanced EOC.
晚期上皮性卵巢癌（EOC）死亡率高，通常首先采用新辅助化疗（NACT），随后进行减瘤手术。有或没有机器人辅助的腹腔镜手术（微创手术（MIS））可能是这些患者的一个有益选择。本综述的目的是明确MIS在选定的晚期EOC患者管理中的地位。
本综述使用了PubMed、Cochrane和Clinicaltrials.gov在线数据库，以选择英文或法文发表的文章。
我们选择了2015年至2020年间发表的11篇原创文章，其中6篇比较了MIS和开腹手术。在这11项研究中，8项为回顾性队列研究，2项为II期试验，1项为病例对照研究。总共有3721例患者，其中854例（23%）接受了MIS治疗。224例（26%）MIS患者使用了机器人辅助。具体来看MIS患者，中转开腹率为9.5%，完全切除率（CC-0）为83.4%。最后，MIS术中并发症发生率为1%，术后为12%。MIS组和开腹手术组患者的完全切除率、术后并发症以及总生存期（OS）相当。一项研究发现，MIS组的无病生存期（DFS）优于开腹手术组（18个月对12个月；P=0.027）。
与开腹手术相比，MIS在NACT后完成细胞减灭术似乎是可行、有效且可靠的，且不影响肿瘤学安全性。需要进行前瞻性随机对照试验来证实MIS在晚期EOC中的作用。
