Department of Gynecologic Oncology, ARNAS G. Brotzu, Cagliari, Italy.
Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
BMC Surg. 2021 Oct 28;21(1):380. doi: 10.1186/s12893-021-01368-z.
This study investigated the feasibility and safety of laparoscopic splenectomy conducted in the contexts of both laparoscopic secondary surgery for isolated recurrence in the spleen and primary laparoscopic cytoreductive surgery for advanced ovarian cancer.
We performed a perspective observational study including all consecutive patients with ovarian cancer who underwent laparoscopic splenectomy as part of primary cytoreductive procedures for advanced stage ovarian cancer or secondary surgery for isolated splenic recurrence between January 2016 and May 2020.
We enrolled 13 consecutive patients, candidate to laparoscopic splenectomy as part of primary cytoreductive procedures for advanced stage ovarian cancer (6 patients) or secondary surgery for isolated splenic recurrence of platinum-sensitive ovarian cancer (7 patients). Median operative time (509 min [range, 200-845]) for primary cytoreductive surgery varied according to surgical complexity depending on the extensiveness of the disease. Median operative time for secondary surgery for isolated splenic metastasis was 253 min (90-380). Only 1 patient with isolated splenic recurrence required conversion to an open approach. No intraoperative complication occurred, and no intraoperative blood transfusions were required. Median hospital stay was 3 days (range, 2-5) for isolated recurrence and 9 days (7-18) for primary cytoreductive surgery. Complete tumor resection was achieved in all patients. Median time from surgery to adjuvant chemotherapy was 16 days (7-24). All six patients who underwent laparoscopic splenectomy during primary cytoreductive surgery remain alive, four of whom exhibit no evidence of disease (median follow-up 25 months [4-36]). Among patients who underwent laparoscopic splenectomy during secondary surgery for isolated splenic relapse, all patients are alive and only one had a central diaphragmatic relapse 2 years after surgery (median follow-up 17 months ([5-48 months]).
The laparoscopic approach to splenectomy is feasible and safe both in patients undergoing primary cytoreductive surgery for advanced stage disease and those with isolated recurrence of ovarian cancer, without compromising survival and allowing early initiation of postoperative systemic chemotherapy.
本研究旨在探讨腹腔镜脾切除术应用于孤立性脾复发的腹腔镜二次手术和晚期卵巢癌的原发性腹腔镜细胞减灭术的可行性和安全性。
我们进行了一项前瞻性观察研究，纳入了 2016 年 1 月至 2020 年 5 月期间所有因晚期卵巢癌行腹腔镜脾切除术作为原发性细胞减灭术一部分或因铂类敏感卵巢癌孤立性脾转移行二次手术的卵巢癌患者。
我们共纳入 13 例连续患者，这些患者候选行腹腔镜脾切除术作为晚期卵巢癌的原发性细胞减灭术（6 例）或铂类敏感卵巢癌孤立性脾转移的二次手术（7 例）。原发性细胞减灭术的中位手术时间（509 分钟[范围 200-845 分钟]）取决于手术的复杂程度，与疾病的广泛性有关。孤立性脾转移的二次手术的中位手术时间为 253 分钟（90-380 分钟）。仅 1 例孤立性脾复发患者需要转为开放手术。无术中并发症，无需术中输血。孤立性脾复发患者的中位住院时间为 3 天（2-5 天），原发性细胞减灭术的中位住院时间为 9 天（7-18 天）。所有患者均达到完全肿瘤切除。手术至辅助化疗的中位时间为 16 天（7-24 天）。在原发性细胞减灭术中行腹腔镜脾切除术的 6 例患者均存活，其中 4 例无疾病证据（中位随访 25 个月[4-36 个月]）。在孤立性脾转移的二次手术中行腹腔镜脾切除术的 7 例患者均存活，其中 1 例术后 2 年出现中央膈肌复发（中位随访 17 个月[5-48 个月]）。
腹腔镜脾切除术应用于晚期卵巢癌患者的原发性细胞减灭术和孤立性卵巢癌复发患者均是可行且安全的，不影响生存，并允许早期开始术后全身化疗。
