Pereira Augusto, Magrina Javier F, Magtibay Paul M, Neto Joao Siufi, Siufi Daniela F S, Chang Yu-Hui H, Perez-Medina Tirso
Department of Gynecologic Surgery, Puerta de Hierro University Hospital, 28222 Madrid, Spain.
Department of Medical and Surgical Gynecology, Mayo Clinic Hospital, Phoenix, AZ 85054, USA.
Cancers (Basel). 2022 Jul 22;14(15):3579. doi: 10.3390/cancers14153579.
Neoadjuvant chemotherapy allows a minimally invasive approach for interval debulking in patients with ovarian cancer considered unresectable to no residual disease by laparotomy at diagnosis. The aim of the study was to evaluate the type of surgical approach at interval debulking (ID) after three courses of carboplatin and taxol in patients with unresectable ovarian cancer at diagnosis compared with the type of surgical approach at primary debulking (PD). A secondary objective was to compare the perioperative outcomes of MIS vs. laparotomy at ID. A retrospective review of the type of surgical approach at ID following three courses of carboplatin and taxol was compared with the surgical approach at PD, and a review of the perioperative outcomes of MIS vs. open at ID was performed during the period from 21 January 2012, through 21 February 2013, for stage IIIC > 2 cm or IV epithelial ovarian cancer (EOC) unresectable at diagnosis and the surgical approach at PD. During the study period, 127 patients with stage IIIC or IV EOC met the inclusion criteria. Minimally invasive surgery (MIS), laparoscopic or robotic, was used in 21.6% of patients at ID and in 23.3% of patients at PD. At ID, MIS patients had a shorter hospital stay as compared to laparotomy (2 vs. 8 days; p < 0.001). At 5 year follow-up, 31.5% of EOC patients were alive (ID MIS: 47.5% vs. ID open: 30%; PD MIS: 41% vs. PD open: 28%), while 24.4% had no evidence of disease (ID MIS: 39% vs. ID open: 19.5%; PD MIS: 32% vs. PD open: 22%). Among living patients, 22% had evidence of disease. Neoadjuvant chemotherapy is a form of chemo-debulking and allows a minimally invasive approach at interval debulking in about one-fifth of the patients, with initial disease deemed unresectable to no residual tumor at initial diagnosis.
新辅助化疗为那些在诊断时被认为无法切除、经剖腹手术无法达到无残留疾病的卵巢癌患者提供了一种微创的间歇性肿瘤细胞减灭术方法。本研究的目的是评估在诊断时无法切除的卵巢癌患者接受三个疗程的卡铂和紫杉醇治疗后进行间歇性肿瘤细胞减灭术（ID）时的手术方式类型，并与初次肿瘤细胞减灭术（PD）时的手术方式类型进行比较。次要目标是比较ID时微创外科手术（MIS）与剖腹手术的围手术期结局。对127例符合纳入标准的IIIC期＞2 cm或IV期上皮性卵巢癌（EOC）患者在2012年1月21日至2013年2月21日期间接受三个疗程的卡铂和紫杉醇治疗后ID时的手术方式类型与PD时的手术方式进行回顾性比较，并对ID时MIS与开腹手术的围手术期结局进行回顾。在研究期间，127例IIIC期或IV期EOC患者符合纳入标准。ID时21.6%的患者以及PD时23.3%的患者采用了微创外科手术（MIS），即腹腔镜手术或机器人手术。ID时，MIS患者的住院时间比剖腹手术患者短（2天对8天；p＜0.001）。在5年随访时，31.5%的EOC患者存活（ID时MIS组：47.5%对ID时开腹组：30%；PD时MIS组：41%对PD时开腹组：28%），而24.4%的患者无疾病证据（ID时MIS组：39%对ID时开腹组：19.5%；PD时MIS组：32%对PD时开腹组：22%）。在存活患者中，22%有疾病证据。新辅助化疗是一种化疗减瘤形式，约五分之一的患者在间歇性肿瘤细胞减灭术时可采用微创方法，初始疾病在初次诊断时被认为无法切除直至无残留肿瘤。
