Department of Obstetrics and Gynecology, Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
J Gynecol Oncol. 2023 Mar;34(2):e17. doi: 10.3802/jgo.2023.34.e17. Epub 2022 Dec 8.
We evaluated the usefulness of preoperative diagnostic laparoscopy for treatment planning in patients with advanced-stage ovarian cancer.
We retrospectively analyzed 614 patients diagnosed with advanced-stage ovarian cancer between January 2010 and May 2018. Primary debulking surgery (PDS) or neoadjuvant chemotherapy (NAC) followed by interval debulking surgery were selected based on preoperative laparoscopic (Group 1, n=192) and computed tomography findings (Group 2, n=422). The primary outcomes in the PDS and NAC groups were suboptimal cytoreduction (residual disease >1 cm) rate and non-high-grade serous carcinoma (non-HGSC) rate, respectively.
The patients who underwent PDS in group 1 and group 2 were 49 (25.5%) and 279 (66.1%), respectively. The suboptimal cytoreduction rate after PDS was lower in Group 1 than in Group 2 (2.0% vs 11.1%, p=0.023). Moreover, Group 1 showed a tendency toward a lower proportion of non-HGSC patients who underwent NAC than that in Group 2 (9.1% vs. 15.4%, p=0.069). Further, Group 1 showed lower rates of postoperative morbidity than Group 2 (5.2% vs. 10.4%, p=0.033). However, Kaplan-Meier analysis showed no significant differences in survival outcomes between the 2 groups.
Diagnostic laparoscopy reduced the suboptimal cytoreduction rate in the PDS group and the implementation rate of NAC in non-HGSC patients. Moreover, it reduced postoperative morbidity without affecting survival in both groups. Thus, diagnostic laparoscopy is a valuable diagnostic tool for determining the primary treatment.
我们评估了术前诊断性腹腔镜检查在晚期卵巢癌患者治疗计划中的作用。
我们回顾性分析了 2010 年 1 月至 2018 年 5 月期间诊断为晚期卵巢癌的 614 例患者。根据术前腹腔镜（组 1，n=192）和计算机断层扫描（组 2，n=422）结果选择初次肿瘤细胞减灭术（PDS）或新辅助化疗（NAC）后间隔肿瘤细胞减灭术。PDS 和 NAC 组的主要结局分别为非理想肿瘤细胞减灭术（残留肿瘤>1cm）率和非高级别浆液性癌（非 HGSC）率。
组 1 和组 2 中分别有 49（25.5%）和 279（66.1%）例患者行 PDS。组 1 行 PDS 后的非理想肿瘤细胞减灭术率低于组 2（2.0% vs 11.1%，p=0.023）。此外，组 1 行 NAC 的非 HGSC 患者比例较组 2有降低趋势（9.1% vs. 15.4%，p=0.069）。而且，组 1 的术后发病率低于组 2（5.2% vs. 10.4%，p=0.033）。然而，Kaplan-Meier 分析显示两组的生存结局无显著差异。
诊断性腹腔镜检查降低了 PDS 组的非理想肿瘤细胞减灭术率和非 HGSC 患者的 NAC 实施率。此外，它降低了术后发病率，而不影响两组的生存。因此，诊断性腹腔镜检查是确定主要治疗方法的一种有价值的诊断工具。
