Winicki Nolan M, Radomski Shannon N, Florissi Isabella S, Wethington Stephanie, de Hingh Ignace, Villeneuve Laurent, Glehen Olivier, Esquivel Jesus, Bhatt Aditi, Johnston Fabian M, Greer Jonathan B
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
School of Medicine, University of California Riverside, Riverside, CA, USA.
Ann Surg Oncol. 2025 Feb;32(2):671-678. doi: 10.1245/s10434-024-16116-9. Epub 2024 Oct 24.
No guidelines exist regarding the management of the uninvolved uterus or adnexa (fallopian tubes and/or ovaries) in patients with peritoneal metastases (PM) from non-gynecologic malignancies. It is unclear whether salpingo-oophorectomy, hysterectomy, or both should be performed when a complete pelvic peritonectomy is otherwise warranted.
A 25-item electronic survey was sent to 225 surgeons worldwide who routinely perform cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). Participants were recruited through listservs of expert groups. Individual surgeon approaches to the management of the grossly uninvolved uterus and adnexa in pre- and post-menopausal women with PM from low- and high-grade appendiceal neoplasms, colorectal cancer, and peritoneal mesothelioma were collected using a 5-point Likert scale.
A total of 135 complete responses (60% response rate) were obtained from surgeons practicing in 27 countries. Respondents reported a median practice of 10 years (interquartile range [IQR] 6-15 years) and a median performance of 20 (IQR 12-30) CRS/HIPEC operations per year. Rates of salpingo-oophorectomy differed by histology and a woman's menopausal status, ranging from 29 to 42% in pre-menopausal women to 71-77% in post-menopausal women (P < 0.001). Notably, the number of surgeons who would perform a hysterectomy was lower, ranging from 12 to 27% for pre-menopausal women and from 32 to 44% for post-menopausal women, dependent on histology (P < 0.001).
Surgeons are overall more aggressive with adnexal resection than with hysterectomy in both pre- and post-menopausal women with PM from non-gynecologic malignancies. Further prospective studies are required to determine the best approach to optimize surgical and oncologic outcomes while also accounting for the fertility and hormonal impact.
对于非妇科恶性肿瘤腹膜转移（PM）患者，目前尚无关于未受累子宫或附件（输卵管和/或卵巢）管理的指南。当有必要进行全盆腔腹膜切除术时，尚不清楚是否应进行输卵管卵巢切除术、子宫切除术或两者都进行。
向全球225名经常进行细胞减灭术（CRS）加腹腔热灌注化疗（HIPEC）的外科医生发送了一份包含25个项目的电子调查问卷。参与者通过专家组的邮件列表招募。使用5点李克特量表收集个体外科医生对绝经前和绝经后患有低级别和高级别阑尾肿瘤、结直肠癌和腹膜间皮瘤的PM患者中大体未受累子宫和附件的管理方法。
来自27个国家的外科医生共获得135份完整回复（回复率60%）。受访者报告的中位执业年限为10年（四分位间距[IQR]6 - 15年），每年进行CRS/HIPEC手术的中位例数为20例（IQR 12 - 30）。输卵管卵巢切除术的比例因组织学类型和女性绝经状态而异，绝经前女性为29%至42%，绝经后女性为71%至77%（P < 0.001）。值得注意的是，进行子宫切除术的外科医生数量较少，绝经前女性为12%至27%，绝经后女性为32%至44%，取决于组织学类型（P < 0.001）。
在患有非妇科恶性肿瘤PM的绝经前和绝经后女性中，总体而言，外科医生对附件切除术比对子宫切除术更积极。需要进一步的前瞻性研究来确定在考虑生育和激素影响的同时优化手术和肿瘤学结果的最佳方法。
