Ni Sha, He Jiaqi, Ouyang Ling
Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.
Int J Surg. 2024 Nov 1;110(11):6922-6932. doi: 10.1097/JS9.0000000000001474.
Limited data are available on patients with advanced-stage epithelial ovarian cancer (OC) who require ostomy during primary cytoreductive surgery. This study aimed to investigate the application of postoperative and long-term oncological results from transitory protective stoma (TPS) formation during primary debulking surgery for OC.
This is a retrospective cohort study with a single center. The authors identified patients with stage III-IV OC who underwent colon resection and anastomosis. Depending on the methods used after colorectal anastomosis and the outcomes of surgical resection, the patients were stratified into three groups: resection and end-to-end anastomosis, resection and ostomy, or R1 resection. Demographic and clinical data were analyzed.
Eighty-four patients underwent colorectal resection during cytoreduction for FIGO stage III-IV OC. Patients undergoing ostomy were more likely to have a longer mean operative time (266 vs. 283 vs. 236 min; P =0.003) and to undergo rectosigmoid resection at the time of cytoreductive surgery (56.0 vs. 22.7%, P =0.007). Their postoperative feeding (7 vs. 1 vs. 3 days, P <0.001) and exhaustion (6 vs. 3 vs. 3, P <0.001) times were similar to those of patients with R1 resection and much earlier than those of patients with intestinal anastomosis. The first normal time (35 days) and half-life (14.68 days) of CA125 after surgery were significantly better in patients with TPS group. The overall incidence of complications was the same, and there was no significant difference in the 30-day readmission rate. The overall quality of life assessment was significantly lower in the R1 resection group.
TPSs can accelerate postoperative recovery and the initiation of postoperative chemotherapy, reduce the risk of mortality and disease progression and limit the incidence of complications.
关于晚期上皮性卵巢癌（OC）患者在初次细胞减灭术中需要造口术的相关数据有限。本研究旨在探讨在OC初次肿瘤细胞减灭术中形成临时性保护造口（TPS）的术后应用及长期肿瘤学结果。
这是一项单中心回顾性队列研究。作者纳入了接受结肠切除和吻合术的III-IV期OC患者。根据结直肠吻合术后使用的方法和手术切除结果，将患者分为三组：切除并端端吻合、切除并造口或R1切除。分析人口统计学和临床数据。
84例患者在FIGO III-IV期OC细胞减灭术中接受了结直肠切除术。接受造口术的患者平均手术时间更长（分别为266、283和236分钟；P = 0.003），且在细胞减灭术时更有可能接受直肠乙状结肠切除术（分别为56.0%、22.7%，P = 0.007）。他们的术后进食时间（分别为7、1和3天，P < 0.001）和疲惫时间（分别为6、3和3天，P < 0.001）与R1切除患者相似，且比肠吻合患者早得多。TPS组患者术后CA125的首次恢复正常时间（35天）和半衰期（14.68天）明显更好。总体并发症发生率相同，30天再入院率无显著差异。R1切除组的总体生活质量评估明显更低。
TPS可加速术后恢复和术后化疗的开始，降低死亡和疾病进展风险，并限制并发症的发生率。
