Sugarbaker T A, Chang D, Koslowe P, Sugarbaker P H
Cancer Institute, Washington Hospital Center, DC 20010, USA.
Cancer Treat Res. 1996;81:63-74. doi: 10.1007/978-1-4613-1245-1_7.
A detailed analysis of the patterns of treatment failure of ovarian malignancy may lead to a more comprehensive understanding of the natural history of the disease. A hypothesis was generated that suggests treatment failure was caused by ovarian cancer persistence and by reimplantation of tumor emboli trapped within surgically traumatized tissues. Nine ovarian cancer patients who had previously undergone standard surgical removal of the primary cancer were prospectively studied at a reoperative procedure. The operative findings at the time of primary cancer surgery and reoperative surgery were scored for the presence of tumor in 9 abdominopelvic regions and 17 abdominopelvic sites. These data were then statistically analyzed. In 7 of the 9 patients ovarian cancer recurrence was associated with an increased intraperitoneal dissemination of tumor. A mean of 3.1 regions were involved at the time of the initial surgery and 5.3 were involved at reoperation. The regions most consistently involved were those in close proximity to the primary cancer. The anatomic sites that showed a preponderance of recurrence were the rectosigmoid colon, cul-de-sac of Douglas, left paracolic gutter, vagina, and abdominal incision. Traumatized sites always showed more cancer recurrence than nontraumatized sites. The vaginal cuff and abdominal incision, sites free of cancer after hysterectomy but at high risk for tumor cell entrapment, were disproportionately common sites for cancer found at reoperation. This study shows that in this reoperative setting ovarian cancer recurrence is most common in the pelvis and the left lower part of the abdomen. The cul-de-sac of Douglas and the rectosigmoid colon are anatomic sites at extreme risk for disease progression. These are sites in which ovarian cancer implants not removed by routine hysterectomy and bilateral salpingo-oophorectomy will persist. Also, sites traumatized by surgery were disproportionately involved by cancer at reoperation. These data may be interpreted to suggest that anatomic sites with cancer persistence and with cancer implantation induced by surgical trauma are the most common sites for ovarian cancer recurrence in this select group of patients.
对卵巢恶性肿瘤治疗失败模式进行详细分析，可能会使我们对该疾病的自然史有更全面的了解。由此产生了一个假说，即治疗失败是由卵巢癌持续存在以及被困于手术创伤组织中的肿瘤栓子再植入所致。对9例先前已接受原发性癌症标准手术切除的卵巢癌患者进行了再次手术的前瞻性研究。对原发性癌症手术和再次手术时的手术发现，就9个腹盆腔区域和17个腹盆腔部位的肿瘤存在情况进行评分。然后对这些数据进行统计分析。9例患者中有7例卵巢癌复发与肿瘤腹腔内播散增加有关。初次手术时平均累及3.1个区域，再次手术时累及5.3个区域。最常累及的区域是紧邻原发性癌症的区域。复发占优势的解剖部位是直肠乙状结肠、Douglas陷凹、左结肠旁沟、阴道和腹部切口。受创伤部位的癌症复发总是比未受创伤部位更多。阴道断端和腹部切口，子宫切除术后本无癌症但有肿瘤细胞滞留高风险的部位，在再次手术时发现癌症的比例过高。本研究表明，在这种再次手术情况下，卵巢癌复发最常见于盆腔和左下腹。Douglas陷凹和直肠乙状结肠是疾病进展风险极高的解剖部位。这些是常规子宫切除及双侧输卵管卵巢切除未能切除的卵巢癌种植部位将会持续存在的部位。此外，手术创伤部位在再次手术时癌症累及比例过高。这些数据可以解释为提示，在这组特定患者中，癌症持续存在以及手术创伤诱导癌症种植的解剖部位是卵巢癌复发最常见的部位。
