Shin Wonkyo, Mun Jaehee, Park Sang-Yoon, Lim Myong Cheol
Department of Obstetrics & Gynecology, Chungnam National University Sejong Hospital, Sejong, Korea.
Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Gland Surg. 2021 Mar;10(3):1212-1217. doi: 10.21037/gs-20-422.
Epithelial ovarian cancer is the most lethal among gynecologic cancers. Despite advances in research efforts to cure this disease, the recurrence and survival rates have not significantly improved. Primary cytoreductive surgery and adjuvant chemotherapy are the standard treatment options for patients with epithelial ovarian cancer. Two randomized trials recently introduced neoadjuvant chemotherapy followed by interval cytoreductive surgery as an alternative treatment option. In any case, the size of the residual tumor after surgery is the most important prognostic factor for patients with ovarian cancer. With the improvement of surgical techniques in gynecologic oncology, cytoreductive surgery is now performed for the pelvic area and entire abdomen. Currently, surgical resectability of a mass spreading into the upper abdomen is the most important factor for achieving optimal cytoreduction. In this study, we explain the procedure of a cytoreductive surgery, involving the resection of a tumor located in the upper abdomen. We aimed to review and describe the surgical techniques involved in liver mobilization, diaphragm peritonectomy, and full-thickness diaphragm resection and reconstruction. Further, we have assessed the postoperative care involved and discussed complications that may possibly arise along with suggestions to avoid them based on the review of previous literature on the subject.
上皮性卵巢癌是妇科癌症中致死率最高的。尽管在攻克这种疾病的研究方面取得了进展，但复发率和生存率并未显著提高。初次肿瘤细胞减灭术和辅助化疗是上皮性卵巢癌患者的标准治疗选择。最近的两项随机试验引入了新辅助化疗，随后进行间隔期肿瘤细胞减灭术作为一种替代治疗选择。无论如何，手术后残留肿瘤的大小是卵巢癌患者最重要的预后因素。随着妇科肿瘤学手术技术的提高，现在针对盆腔和整个腹部进行肿瘤细胞减灭术。目前，肿瘤扩散至上腹部时的手术可切除性是实现最佳肿瘤细胞减灭的最重要因素。在本研究中，我们阐述了涉及切除上腹部肿瘤的肿瘤细胞减灭术的过程。我们旨在回顾和描述肝脏游离、膈肌腹膜切除术以及全层膈肌切除与重建所涉及的手术技术。此外，我们评估了术后护理情况，并根据对该主题以往文献的回顾，讨论了可能出现的并发症以及避免这些并发症的建议。
