Schmalfeldt Barbara
Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
Chirurgie (Heidelb). 2022 Dec;93(12):1144-1151. doi: 10.1007/s00104-022-01728-2. Epub 2022 Oct 6.
The achievement of macroscopically complete tumor resection in primary debulking surgery is the most important prognostic factor in advanced ovarian cancer. This results in a median survival benefit of >5 years. Systematic lymphadenectomy (LNE) is not indicated in advanced ovarian cancer with inconspicuous lymph nodes as it does not prolong overall survival and therefore should no longer be carried out above stage IIB with inconspicuous lymph nodes in imaging and by palpation. Primary cytoreductive surgery is the standard in advanced ovarian cancer. Neoadjuvant therapy is currently an option only if primary cytoreduction does not appear to be possible. For the use of hyperthermic intraperitoneal chemotherapy (HIPEC) in primary debulking surgery a survival benefit has so far not been proven and therefore HIPEC is not recommended in this setting.
在初次肿瘤细胞减灭术中实现宏观上的肿瘤完全切除是晚期卵巢癌最重要的预后因素。这可带来超过5年的中位生存获益。对于影像学检查和触诊未发现明显肿大淋巴结的晚期卵巢癌，不建议进行系统性淋巴结清扫术（LNE），因为其并不能延长总生存期，因此对于影像学检查和触诊未发现明显肿大淋巴结的IIB期以上患者不应再进行该手术。初次肿瘤细胞减灭术是晚期卵巢癌的标准治疗方法。目前，仅在初次肿瘤细胞减灭术似乎无法实施时，新辅助治疗才是一种选择。对于在初次肿瘤细胞减灭术中使用腹腔内热灌注化疗（HIPEC），目前尚未证实其具有生存获益，因此不建议在此情况下使用HIPEC。
