McNamara Blair, Guerra Rosa, Qin Jennifer, Craig Amaranta D, Chen Lee-May, Varma Madhulika G, Chapman Jocelyn S
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA 94143, USA.
Department of Gynecologic Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
Gynecol Oncol Rep. 2021 Sep 25;38:100870. doi: 10.1016/j.gore.2021.100870. eCollection 2021 Nov.
To evaluate the impact of bowel resection at the time of interval cytoreductive surgery on survival.
We identified patients with advanced ovarian cancer who underwent neoadjuvant chemotherapy and interval cytoreductive surgery between 2008 and 2018 from a single-institution tumor registry. Kaplan-Meier survival analysis and Cox proportional hazards models were performed comparing patients who underwent bowel resection to those who did not.
Of 158 patients, 43 (27%) underwent bowel resection. Rates of optimal (95%) and sub-optimal (5%) resection did not differ with bowel resection. Patients that required bowel resection had worse three-year survival (43% vs. 63%), even after adjusting for confounding variables of age, stage, number of neoadjuvant cycles, R0 resection, and ASA score (HR 2.27, p < 0.01). Adjusted progression-free survival did not differ between groups (HR 0.92, p = 0.72). Patients who underwent bowel resection were more likely to require blood transfusion (p < 0.01), and have a longer hospital stay (5 days vs 7.5 days, p < 0.01).
Bowel resection at the time of interval cytoreduction confers a greater than 2-fold increased risk of mortality and does not impact progression-free survival. Long-term sequelae of the -operative morbidity of bowel resection may contribute to increased mortality, and bowel resection may be a surrogate for disease biology with poor prognosis.
评估间歇性肿瘤细胞减灭术时肠切除对生存的影响。
我们从一个单机构肿瘤登记处识别出2008年至2018年间接受新辅助化疗和间歇性肿瘤细胞减灭术的晚期卵巢癌患者。采用Kaplan-Meier生存分析和Cox比例风险模型，比较接受肠切除的患者和未接受肠切除的患者。
158例患者中，43例（27%）接受了肠切除。最佳（95%）和次优（5%）切除率在肠切除组和非肠切除组之间无差异。即使在调整了年龄、分期、新辅助化疗周期数、R0切除和ASA评分等混杂变量后，需要进行肠切除的患者三年生存率仍较低（43%对63%）（HR 2.27，p<0.01）。调整后的无进展生存期在两组之间无差异（HR 0.92，p=0.72）。接受肠切除的患者更有可能需要输血（p<0.01），且住院时间更长（5天对7.5天，p<0.01）。
间歇性肿瘤细胞减灭术时进行肠切除会使死亡风险增加两倍以上，且不影响无进展生存期。肠切除手术并发症的长期后遗症可能导致死亡率增加，肠切除可能是疾病生物学预后不良的一个替代指标。
