Laven P, Beltman J J, Bense J E, van der Aa M A, Van Gorp T, Vos M C, Boll D, Arts Hgj, Reesink N, Trimbos J B, Kruitwagen Rfpm
Maastricht University Medical Centre, Department of Obstetrics and Gynecology and GROW - School for Oncology and Developmental Biology, P.O. Box 5800, 6202AZ Maastricht, The Netherlands.
Leiden University Medical Centre, Department of Obstetrics and Gynecology, Leiden, The Netherlands.
Surg Open Sci. 2021 Oct 14;7:6-11. doi: 10.1016/j.sopen.2021.09.002. eCollection 2022 Jan.
Incomplete surgical staging of patients with early-stage epithelial ovarian cancer (EOC) has been reported in up to 98% of cases, when based on the International Federation of Obstetrics and Gynecology (FIGO) staging procedure. The aim of the present retrospective study was to clarify the reasons for incomplete staging.
The PRISMA (Prevention Recovery Information System for Monitoring and Analysis) technique was used to evaluate cases with FIGO I-IIa EOC based on incomplete staging from five gynecologic oncologic center hospitals in the Netherlands in the period 2010-2014.
Fifty cases with an incomplete surgical staging of EOC according to national guidelines were included. The most common reasons for incomplete staging were insufficient random biopsies of the peritoneum (n = 34, 68%), and less than ten lymph nodes being resected and/or found at pathology (n = 16, 32%). The most mentioned reason for not performing biopsies was, besides forgetting to do so, believing that after careful inspection and palpation, taking biopsies is irrelevant and/or already are being taken while performing a hysterectomy (peritoneum of cul-de-sac, bladder). The value of contralateral pelvic lymph node dissection in case of a unilateral ovarian malignancy was also doubted, influencing the number of lymph nodes resected.
The most important reasons for incomplete staging in EOC are, besides omitting elements by accident, questioning the importance of obligatory elements of the staging procedure. A structured list of staging steps during surgery and more evidence-based consensus concerning these obligatory elements might increase the number of complete staging procedures in EOC.
据报道，按照国际妇产科联盟（FIGO）分期程序，高达98%的早期上皮性卵巢癌（EOC）患者手术分期不完整。本回顾性研究的目的是阐明分期不完整的原因。
采用PRISMA（监测与分析预防恢复信息系统）技术，对2010 - 2014年期间荷兰五家妇科肿瘤中心医院基于分期不完整的FIGO I-IIa期EOC病例进行评估。
纳入了50例根据国家指南手术分期不完整的EOC病例。分期不完整最常见的原因是腹膜随机活检不足（n = 34，68%），以及病理检查时切除和/或发现的淋巴结少于10个（n = 16，32%）。除了忘记进行活检外，不进行活检最常提到的原因是，认为在仔细检查和触诊后，活检无关紧要和/或在进行子宫切除术（直肠子宫陷凹、膀胱的腹膜）时已经进行了活检。对于单侧卵巢恶性肿瘤患者，对侧盆腔淋巴结清扫的价值也受到质疑，这影响了切除的淋巴结数量。
EOC分期不完整的最重要原因，除了偶然遗漏某些要素外，还在于对分期程序中必要要素的重要性提出质疑。手术期间分期步骤的结构化清单以及关于这些必要要素的更多循证共识，可能会增加EOC完整分期程序的数量。
