机器人或腹腔镜盆腔切除术治疗妇科恶性肿瘤:开放手术的可行选择。
Robotic or laparoscopic pelvic exenteration for gynecological malignancies: feasible options to open surgery.
发表日期:2023 Oct 19
作者:
Laura Dudus, Corina Minciuna, Stefan Tudor, Monica Lacatus, Bogdan Stefan, Catalin Vasilescu
来源:
Journal of Gynecologic Oncology
摘要:
承认微创盆腔廓清术是开放手术的可行替代方案,并有可能确定患者结果的预测因素。该研究旨在对 2008 年 1 月至 2022 年 1 月期间连续 12 例病例进行回顾性单团队分析。6 例前位手术和 6 例前位手术进行了全盆腔廓清术。 75% 的病例使用机器人方法进行治疗。 4 例采用回肠导管进行泌尿道重建。平均手术时间为 360±30.7 分钟。前骨盆廓清术 440±40.7 分钟。总盆腔廓清术和平均失血量为 350±35 mL。 9 例(75%)进行了 R0 切除,围手术期发病率为 16.6%,无死亡记录。中位无病生存期为 12 个月 (10-14),总生存期 (OS) 为 20 个月 (1-127)。就 OS 而言,50% 的患者术后 24 个月仍存活。考虑到随访时间,50岁以下或70岁以上的女性中有16.6%未达到临界点,未达到临界点的6名患者中有4人被诊断为远处转移或局部复发(p=0.169)。我们的经验与有关癌症原发部位、术后并发症、R0 切除和生存率的文献非常一致。另一方面,微创方法和泌尿道重建类型与引用的出版物相反。只要患者选择得当,微创盆腔廓清术确实是一种安全可行的手术。© 2024。亚洲妇科肿瘤学会、韩国妇科肿瘤学会和日本妇科肿瘤学会。
To acknowledge that minimally invasive pelvic exenteration is a feasible alternative to open surgery and potentially identify prediction factors for patient outcome.The study was designed as a retrospective single team analysis of 12 consecutive cases, set between January 2008 and January 2022.Six anterior and 6 total pelvic exenterations were performed. A 75% of cases were treated using a robotic approach. In 4 cases, an ileal conduit was used for urinary reconstruction. Mean operative time was 360±30.7 minutes. for anterior pelvic exenterations and 440±40.7 minutes. for total pelvic exenterations and mean blood loss was 350±35 mL. An R0 resection was performed in 9 cases (75%) and peri-operative morbidity was 16.6%, with no deaths recorded. Median disease-free survival was 12 months (10-14) and overall survival (OS) was 20 months (1-127). In terms of OS, 50% of patients were still alive 24 months after surgery. Taking into consideration the follow up period,16.6% of females under 50 or above 70 years old did not reach the cut off and 4 out of 6 patients that failed to reach it were diagnosed with distant metastases or local recurrence (p=0.169).Our experience is very much consistent with literature in regard to primary site of cancer, post-operative complications, R0 resection and survival rates. On the other hand, minimally invasive approach and urinary reconstruction type were in contrast with cited publications. Minimally invasive pelvic exenteration is indeed a safe and feasible procedure, providing patients selection is appropriately performed.© 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.