Tortajada Valle Marta, Agustí Núria, Fusté Pere, Mensión Eduard, Díaz-Feijóo Berta, Glickman Ariel, Marina Tiermes, Torné Aureli
Gynecology Oncology Unit, Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, 08036 Barcelona, Spain.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
J Clin Med. 2024 Sep 14;13(18):5458. doi: 10.3390/jcm13185458.
To assess the long-term oncological safety of laparoscopic fertility-sparing surgery (FSS) in borderline ovarian tumors and the impact of laparoscopic surgical factors on recurrences. Primary outcomes were the recurrence rate and time to recurrence after laparoscopic FSS. Secondary outcomes were to evaluate the recurrence rate after a second laparoscopic surgery and to assess factors associated with the risk of relapse. This is a retrospective single-center observational study in a tertiary university-affiliated hospital. Thirty-four patients diagnosed with borderline ovarian tumors who underwent laparoscopic FSS were recruited. Patients were categorized into two groups: the adnexectomy group, including patients who underwent unilateral adnexectomy, and the cystectomy group, which included patients who underwent unilateral cystectomy, bilateral cystectomy, and unilateral adnexectomy with contralateral cystectomy. Eleven relapses (32.3%) were observed during a median follow-up period of 116.1 [62.5-185.4] months. The recurrence rate was similar for patients who underwent cystectomy (6/19, 31.6%) and adnexectomy (5/15, 33.3%). Cystectomy led to a shorter time to first recurrence (36-month progression-free survival rates of 66% vs. 85%) and higher rates of capsular rupture (71.4% vs. 20%, = 0.04) compared to adnexectomy. No deaths due to progression of disease were reported. Laparoscopic FSS for borderline ovarian tumors is a safe, long-term oncological option. Although the recurrence rate was similar in patients undergoing adnexectomy or cystectomy, the time to recurrence was shorter in cases treated with cystectomy. Further research is needed to identify eventual laparoscopic risk factors more strongly correlated with recurrence.
评估腹腔镜保留生育功能手术（FSS）治疗卵巢交界性肿瘤的长期肿瘤学安全性以及腹腔镜手术因素对复发的影响。主要结局指标为腹腔镜FSS术后的复发率和复发时间。次要结局指标为评估二次腹腔镜手术后的复发率，并评估与复发风险相关的因素。这是一项在一所三级大学附属医院进行的回顾性单中心观察性研究。招募了34例诊断为卵巢交界性肿瘤并接受腹腔镜FSS的患者。患者分为两组：附件切除术组，包括接受单侧附件切除术的患者；囊肿切除术组，包括接受单侧囊肿切除术、双侧囊肿切除术以及单侧附件切除术加对侧囊肿切除术的患者。在中位随访期116.1[62.5 - 185.4]个月期间观察到11例复发（32.3%）。接受囊肿切除术的患者（6/19，31.6%）和附件切除术的患者（5/15，33.3%）的复发率相似。与附件切除术相比，囊肿切除术导致首次复发时间更短（36个月无进展生存率分别为66%和85%），包膜破裂率更高（71.4%对20%，P = 0.04）。未报告因疾病进展导致的死亡。腹腔镜FSS治疗卵巢交界性肿瘤是一种安全的长期肿瘤学选择。尽管接受附件切除术或囊肿切除术的患者复发率相似，但囊肿切除术治疗的病例复发时间更短。需要进一步研究以确定与复发更密切相关的最终腹腔镜危险因素。
