[1]侯征 牛子儒 郭红燕 韩劲松 吴郁 梁华茂*.晚期上皮性卵巢癌腹腔镜和开腹初次肿瘤细胞减灭术对比分析[J].中国微创外科杂志,2021,01(3):199-204.
　Hou Zheng,Niu Ziru,Guo Hongyan,et al.Comparative Analysis of Laparoscopic and Laparotomic Primary Debulking Surgery for Advanced Epithelial Ovarian Cancer[J].Chinese Journal of Minimally Invasive Surgery,2021,01(3):199-204.
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晚期上皮性卵巢癌腹腔镜和开腹初次肿瘤细胞减灭术对比分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年3期
页码:
199-204
栏目:
临床论著
出版日期:
2021-04-01

文章信息/Info

Title:
Comparative Analysis of Laparoscopic and Laparotomic Primary Debulking Surgery for Advanced Epithelial Ovarian Cancer
作者:
侯征 牛子儒 郭红燕 韩劲松 吴郁 梁华茂*
（北京大学第三医院妇产科，北京100191）
Author(s):
Hou Zheng;  Niu Ziru;  Guo Hongyan;  et al.
Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
关键词:
晚期上皮性卵巢癌; 初次肿瘤细胞减灭术; 腹腔镜手术; 开腹手术; 预后
Keywords:
Advanced epithelial ovarian cancer; Primary debulking surgery; Laparoscopy; Laparotomy; Prognosis
文献标志码:
A
摘要:
目的探讨晚期上皮性卵巢癌腹腔镜初次肿瘤细胞减灭术的可行性和安全性。方法回顾性分析2010年1月~2019年12月肿瘤直径≤10 cm的国际妇产科联盟（International Federation of Gynecology and Obstetrics,FIGO）手术病理分期为Ⅲa~Ⅳ期上皮性卵巢癌126例资料，行腹腔镜手术50例，开腹手术76例。2组年龄、BMI、肿瘤直径、手术病理分期、病理类型和病理分级差异均无统计学意义（P>0.05）。比较2组手术参数及随访结果。结果与开腹组相比，腹腔镜组手术时间短［(344.6±125.9）min vs. (443.1±124.2)min,t=-4.335,P=0.000］，出血少［中位数200（20~2000）ml vs. 600（50~3500）ml,Z=-6.241,P=0.000］，术后排气早［2（1~7）d vs. 4（1~13）d,Z=-5.380,P=0.000］，开始化疗早［11.5（3~39）d vs. 15.5（8~65）d,Z=-2.724,P=0.006］，但肿瘤细胞减灭术满意率低［32.0%（26/50） vs. 64.5%（49/76）， χ2=12.734，P=0.000］。2组并发症发生率差异无统计学意义（P=0.960）。腹腔镜组和开腹组无进展生存期（中位数35月vs. 27月，logrank χ2=0.861，P=0.353）和总生存率（3年生存率86.6% vs. 77.6%，5年生存率70.0% vs. 58.9%，logrank χ2=1.381，P=0.240）差异均无统计学意义。结论经过严格选择的晚期上皮性卵巢癌行腹腔镜初次肿瘤细胞减灭术是可行的，其预后并不逊于开腹手术。
Abstract:
ObjectiveTo assess the feasibility and outcome of primary laparoscopic debulking surgery on advanced epithelial ovarian cancer in comparison with conventional laparotomy surgery. MethodsWe retrospectively analyzed 126 patients who were diagnosed as International Federation of Gynecology and Obstetrics (FIGO) stage Ⅲ/Ⅳ epithelial ovarian cancer with tumor diameter ≤10 cm, from January 2010 to December 2019 in our hospital, including 50 of laparoscopy surgery and 76 patients of laparotomy surgery. The differences in age, BMI, tumor diameter, surgical pathology stage, pathological type and pathological classification were not statistically significant (P>0.05). The surgical parameters and followup results of 2 groups were compared.ResultsLaparoscopy group had shorter surgery time ［(344.6±125.9) min vs. (443.1±124.2) min, t=-4.335, P=0.000］, less blood loss ［median 200 (20-2000) ml vs. 600 (50-3500) ml, Z=-6.241, P=0.000］, less postoperative exhaust time ［2 (1-7) d vs. 4 (1-13) d, Z=-5.380, P=0.000］ and earlier to begin the first cycle of adjuvant chemotherapy ［11.5 (3-39) d vs. 155 (8-65) d, Z=-2.724, P=0.006］ than the laparotomy group. But the satisfaction rate of debulking in laparoscopy group was lower than laparotomy group ［32.0% (26/50) vs. 64.5% (49/76), χ2=12.734, P=0.000］. There was no significant difference in the incidence of complications in the 2 groups (P=0.960). The two groups had no significant difference in progression free survival (PFS) and overall survival (OS) (median PFS: 35 months vs. 27 months, logrank χ2=0.861, P=0.353; 3year OS: 86.6% vs. 77.6%, 5year OS: 70.0% vs. 58.9%, logrank χ2=1.381, P=0.240).ConclusionLaparoscopic debulking surgery in some strictly selected advanced stages of epithelial ovarian cancer patients was feasible and safe, prognosis is no inferior than laparotomy surgery.

参考文献/References:

[1]NCCN Clinical Practice Guidelines in Oncology.Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer(2020 Version I).http://www.nccn.org.
[2]Fagotti A,Ferrandina G,Fanfani F,et al.A laparoscopybased score to predict surgical outcome in patients with advanced ovarian carcinoma:a pilot study.Ann Surg Oncol,2006,13(8):1156-1161.
[3]Liang HM,Guo HY,Zhang CY,et al.Feasibility and outcome of primary laparoscopic cytoreductive surgery for advanced epithelial ovarian cancer: a comparison to laparotomic surgery in retrospective cohorts.Oncotarget,2017,8(68):113239-113247.
[4]Fagotti A,Fanfani F,Ludovisi M,et al.Role of laparoscopy to assess the chance of optimal cytoreductive surgery in advanced ovarian cancer:a pilot study.Gynecol Oncol,2005,96(3):729-735.
[5]Fagotti A,Ferrandina G,Fanfani F,et al.Prospective validation of a laparoscopic predictive model for optimal cytoreduction in advanced ovarian carcinoma.Am J Obstet Gynecol,2008,199(6):642.e1-6.
[6]Fagotti A,Vizzielli G,Gostantini B,et al.Learning curve and pitfalls of a laparoscopic score to describe peritoneal carcinosis in advanced ovarian cancer.Acta Obstet Gynecol Scand,2011,90(10):1126-1131.
[7]Fagotti A,Vizzielli G,De laco P,et al.A multicentric trial (OlympiaMITO 13) on the accuracy of laparoscopy to assess peritoneal spread in ovarian cancer.Am J Obstet Gynecol,2013,209(5):462.e1-462.e11.
[8]Fagotti A,Vizzielli G,Fanfani F,et al.Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience.Gynecol Oncol,2013,131(2):341-346.
[9]窦莎,李艺,崔恒,等.腹腔镜评估预测晚期卵巢癌满意肿瘤细胞减灭术的研究进展.中华妇产科临床杂志,2018,19(4):374-376.
[10]Onda T,Satoh T,Saito T,et al.Comparison of survaival between upfront primary debulking surgery versus neoadjuvant chemotherapy for stage III/IV ovarian, tubal and peritoneal cancers in phase III randomized trial: JCOG0602.J Clin Oncol,2018,36(15Suppl):5500.
[11]Gao Y,Li Y,Zhang CY,et al.Evaluating the benefits of neoadjuvant chemotherapy for advanced epithelial ovarian cancer: a retrospective study.J Ovarian Res,2019,12(1):85.
[12]Ceccaroni M,Roviglione G,Bruni F,et al.Laparoscopy for primary cytoreduction with multivisceral resections in advanced ovarian cancer:prospective validation.“The times they are achangin”?Surg Endosc,2018,32(4):2026-2037.
[13]Nezhat FR,DeNoble SM,Liu CS,et al.The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian,fallopian tube,and primary peritoneal cancers.JSLS,2010,14(2):155-168.
[14]倪琴,米鑫,张凤格,等.晚期卵巢癌腹腔镜肿瘤细胞减灭术的安全性和有效性分析.中国微创外科杂志,2017,17(12):1083-1086,1100.
[15]柳禹,曹莉莉,周莉,等.晚期上皮性卵巢癌经腹腔镜和开腹的初次肿瘤细胞减灭术或中间型减瘤术的临床对比研究.实用妇产科杂志,2020,36(4):298-302.
[16]Gueli AS,Capozzi VA,Rosati A,et al.Laparoscopy vs. laparotomy for advanced ovarian cancer: a systematic review of the literature.Minerva Med,2019,110(4):341-357.
[17]Nezhat FR,Cho JE,Liu C,et al.Laparoscopic cytoreduction for advanced primary and recurrent ovarian,fallopian tube,or primary peritoneal cancer.J Minimal Invas Gynecol,2009,16:S39-S40.
[18]Fanning J,Yacoub E,Hojat R.Laparoscopicassisted cytoreduction for primary advanced ovarian cancer: success, morbidity and survival.Gynecol Oncol,2011,123(1):47-49.
[19]Melamed A,Nitecki R,Boruta DM,et al.Laparoscopy compared with laparotomy for debulking ovarian cancer after neoadjuvant chemotherapy.Obstet Gynecol,2017,129(5):861-869.
[20]Jochum F,Vermel M,Faller E,et al.Three and fiveyear mortality in ovarian cancer after minimally invasive compared to open surgery:a systematic review and metaanalysis.J Clin Med,2020,9(8):2507.

备注/Memo

备注/Memo:
*通讯作者，Email：liang_bj@163.com
更新日期/Last Update: 2021-06-09