Stöckle E, Bussières E, Stöckle M, Avril A, Thomas L, Chauvergne J, Brunet R, Pigneux J, Marée D
Service de chirurgie, fondation Bergonié, Bordeaux, France.
Bull Cancer. 1993 Jul;80(7):629-38.
The charts of 147 patients with advanced ovarian cancers responding completely (CR) or partially (PR > 50%) to a primary cisplatin-based chemotherapy are reviewed. All fulfilled our criterias to undergo second-look laparotomy. One hundred patients (group A) underwent second-look laparotomy and 47 patients (group B) other features of control: laparoscopy 37 patients, clinical control ten patients. Apart metastatic spread more frequent in group B (A vs B = 10 vs 32%) and tumor grade 1 more frequent in group B (A vs B = 33 vs 49%), the two groups were well balanced concerning tumor characteristics and treatment features. All patients had received a complementary treatment after the second-look procedures. With a median follow-up of 86 months in group A and 104 months in group B, no difference was found in overall nor in recurrence-free survival. Within group A, 34 patients had achieved pathologic proved complete remission. Their 5-year survival was 73% with an incidence of recurrence of 32%. Second-look laparotomy was found an invasive technique with a 15% operative morbidity. Its therapeutic apport seems absent and the diagnostic role limited to indication of radiotherapy in CR patients. Second-look laparotomies should be reserved to trials evaluating its proper place but should not be used systematically to assess tumor response to chemotherapy. The good 5-year survival of the CR mi group suggest the beneficial impact of complementary treatment, but prospective trials are needed to evaluate the place of this treatment.
回顾了147例晚期卵巢癌患者的病历，这些患者对以顺铂为基础的初始化疗完全缓解（CR）或部分缓解（PR>50%）。所有患者均符合接受二次探查剖腹术的标准。100例患者（A组）接受了二次探查剖腹术，47例患者（B组）采用其他对照方式：腹腔镜检查37例，临床对照10例。除了B组转移扩散更常见（A组与B组分别为10%与32%）以及B组肿瘤1级更常见（A组与B组分别为33%与49%）外，两组在肿瘤特征和治疗特点方面达到良好平衡。所有患者在二次探查手术后均接受了辅助治疗。A组中位随访86个月，B组中位随访104个月，总生存率和无复发生存率均无差异。在A组中，34例患者实现了病理证实的完全缓解。他们的5年生存率为73%，复发率为32%。二次探查剖腹术是一种侵入性技术，手术并发症发生率为15%。其治疗作用似乎不存在，诊断作用仅限于为CR患者指示放疗。二次探查剖腹术应仅用于评估其恰当地位的试验，但不应系统地用于评估肿瘤对化疗的反应。CR亚组良好的5年生存率表明辅助治疗有有益影响，但需要前瞻性试验来评估这种治疗的地位。
