背景:在一些研究中,腹腔镜治疗显示明显的I期卵巢癌(OC)的生存结局和更好的手术结局,但尚未明确定义。
方法:我们对2012年至2022年在两家医院接受治疗的明显I期OC患者进行了回顾性研究。在接受腹腔镜和腹腔镜手术的患者之间评估了手术和肿瘤学结果。
结果:我们确定了37例明显的I期OC患者,包括15例(40.5%)浆液性癌,9例(24.3%)粘液性癌,3(8.1%)内金属类癌,2透明细胞癌,8例(21.6%)非上皮癌。16例患者接受了腹腔镜手术,其他21例患者接受了腹腔镜手术。平均年龄(44.5岁vs.49.0年),平均质量大小(10.5与11.3cm),和中位随访时间(43.5vs.75.0个月)腹腔镜组和开腹组患者间差异无统计学意义(均P>0.05)。所有患者均行全面分期手术,和平均手术时间(213.5vs.203.3分钟,P=0.507),淋巴结采样数量(18.6vs.17.5,P=0.359),升级比例(12.5%与19.0%,P=0.680),术后并发症(无Accordion严重程度分级系统≥3级)在两个手术组之间具有可比性.此外,腹腔镜组患者术中出血量明显减少(231.3vs.352.4mL,P=0.018),手术和术后辅助化疗之间的间隔较短(7.4vs.9.5天,P=0.004),住院时间较短(9.9vs.13.8天,P<0.001)比腹腔镜手术治疗的患者。在54.0个月的中位随访中,9人(24.3%)复发,1人(2.7%)死亡,5年无复发生存率(RFS)和疾病特异性生存率(DSS)分别为70.6%和100%,分别。然而,5年期RFS(93.3%与58.8%,P=0.084)和DSS(100%与100%,P=0.637)的比率在两组之间没有显着差异。
结论:腹腔镜手术治疗术中出血量少,术后早期辅助化疗,住院时间短,与开腹手术相比,明显I期OC的生存结局也不差。
BACKGROUND: Laparoscopic treatment shows non-inferior survival outcomes and better surgical outcomes in apparent stage I ovarian cancer (OC) in some studies but has not been well defined.
METHODS: We conducted a retrospective study of patients with apparent stage I OC treated in two hospitals between 2012 and 2022. The surgical and oncologic outcomes were evaluated between patients receiving laparoscopic and laparotomic surgery.
RESULTS: We identified 37 patients with apparent stage I OC, including 15 (40.5%) serous carcinomas, 9 (24.3%) mucinous cancers, 3 (8.1%) endometroid cancers, 2 clear cell carcinomas, and 8 (21.6%) non-epithelial cancers. Sixteen patients received laparoscopic surgery and the other 21 patients underwent laparotomic surgery. The median age (44.5 vs. 49.0 years), mean mass size (10.5 vs. 11.3 cm), and median follow-up time (43.5 vs. 75.0 months) showed no statistically significant differences between patients in laparoscopic and laparotomic groups (all P > 0.05). All the patients underwent comprehensive surgical staging surgery, and the mean surgical time (213.5 vs. 203.3 min, P = 0.507), number of lymph nodes sampling (18.6 vs. 17.5, P = 0.359), proportion of upstaging (12.5% vs. 19.0%, P = 0.680), and postoperative complications (no Accordion Severity Grading System grade ≥ 3) were comparable between two surgical groups. Moreover, patients in the laparoscopic group had significantly less intraoperative blood loss (231.3 vs. 352.4 mL, P = 0.018), shorter interval between surgery and postoperative adjuvant chemotherapy (7.4 vs. 9.5 days, P = 0.004), shorter length of hospital stay (9.9 vs. 13.8 days, P < 0.001) than those treated with laparotomic surgery. During a median follow-up of 54.0 months, 9 (24.3%) relapsed and 1 (2.7%) died, with a 5-year recurrence-free survival (RFS) and disease-specific survival (DSS) rate of 70.6% and 100%, respectively. However, the 5-year RFS (93.3% vs. 58.8%, P = 0.084) and DSS (100% vs. 100%, P = 0.637) rates did not significantly differ between the two groups.
CONCLUSIONS: Laparoscopic surgical treatment had less intraoperative blood loss, earlier postoperative adjuvant chemotherapy administration, shorter hospitalization time, and non-inferior survival outcomes in apparent stage I OC when compared with laparotomic surgery.