Spirtos N M, Gross G M, Freddo J L, Ballon S C
Women's Cancer Center of Northern California, Palo Alto, USA.
Gynecol Oncol. 1995 Mar;56(3):345-52. doi: 10.1006/gyno.1995.1061.
Beginning in July 1988, a planned program was undertaken to assess the role of aortic and pelvic lymphadenectomy in patients with advanced epithelial cancer of the ovary (Stages IIIa-IVa) undergoing cytoreductive surgery. Our intent was to perform a complete aortic and pelvic lymphadenectomy in all patients in whom we could surgically remove all intra- or retroperitoneal disease measuring 1 cm or greater. Accordingly, 56/77 patients (73%) underwent complete aortic and pelvic lymphadenectomy. The remaining 21/77 patients (27%) did not, either because the lymphadenectomy would not have impacted on the patient's cytoreductive status or because intraoperative conditions precluded it. Positive lymph nodes were found in 36/56 patients (64%). Of these, 23/36 (64%) were macroscopically positive, and if left in situ would have affected the patient's cytoreductive status. Thirteen of 36 (36%) were positive microscopically. Reassessment laparotomy was performed in 44/56 (79%) of the patients having had a lymphadenectomy and is correlated to disease status. Median follow-up is 30 months (range 2-64 months). Survival analysis reveals: 10/20 patients (50%) with negative lymph nodes; 6/13 patients (46%) with microscopically positive lymph nodes; 10/23 patients (43%) with macroscopically positive, but surgically removed lymph nodes; and only 2/21 patients (10%) with residual disease measuring at least 1 cm in diameter are alive without evidence of disease. These preliminary findings suggest that the removal of macroscopically negative lymph nodes offers little benefit to the patient with advanced epithelial cancer and minimal residual (less than 1 cm) disease. However, the concept of cytoreductive surgery, whether it be intra- or retroperitoneal, appears to be validated by the fact that the patients undergoing removal of macroscopically positive lymph nodes have approximately the same chance of survival as those with microscopically positive and/or negative lymph nodes.
从1988年7月开始，我们实施了一项计划项目，以评估主动脉和盆腔淋巴结清扫术在接受肿瘤细胞减灭术的晚期卵巢上皮癌（Ⅲa - Ⅳa期）患者中的作用。我们的目的是对所有能通过手术切除所有直径达1厘米或更大的腹腔内或腹膜后病灶的患者进行完整的主动脉和盆腔淋巴结清扫术。因此，56/77例患者（73%）接受了完整的主动脉和盆腔淋巴结清扫术。其余21/77例患者（27%）未进行清扫，原因要么是淋巴结清扫术对患者的肿瘤细胞减灭状态没有影响，要么是术中情况不允许。56例患者中有36例（64%）发现有阳性淋巴结。其中，23/36例（64%）为肉眼可见阳性，如果原位保留会影响患者的肿瘤细胞减灭状态。36例中有13例（36%）为显微镜下阳性。44/56例（79%）接受了淋巴结清扫术的患者进行了再次剖腹探查，并与疾病状态相关。中位随访时间为30个月（范围2 - 64个月）。生存分析显示：20例淋巴结阴性患者中有10例（50%）存活；13例显微镜下阳性淋巴结患者中有6例（46%）存活；手术切除的肉眼可见阳性淋巴结患者中10/23例（43%）存活；而直径至少1厘米的残留病灶患者中只有2/21例（10%）存活且无疾病证据。这些初步研究结果表明，对于晚期上皮癌且残留病灶极小（小于1厘米）的患者，切除肉眼可见阴性淋巴结对其益处不大。然而，肿瘤细胞减灭术的概念，无论是腹腔内还是腹膜后的，似乎都得到了验证，因为接受切除肉眼可见阳性淋巴结的患者与显微镜下阳性和/或阴性淋巴结患者的生存机会大致相同。
