摘要
目的:比较Ⅳ期卵巢癌患者经微创(minimally invasive surgery, MIS)与开腹方式行间歇性肿瘤细胞减灭术(interval debulking surgery, IDS)的围术期指标和生存结局。方法:本研究采用回顾性研究方法，纳入2017年1月至2021年12月在解放军总医院第一医学中心行IDS所有确诊为Ⅳ期卵巢癌的患者98例，根据手术方式分为开腹组74例和微创组24例，收集两组患者的围术期临床指标并进行随访，比较两组临床疗效和生存结局。结果:微创组与开腹组IDS患者的临床基线均衡可比，两组的术中操作、手术时间和术后残留病灶的差异无统计学意义。微创组比开腹组预估失血量更少，术中输血率更低，术后恢复和开始辅助化疗的时间更短(以上均P<0.001)。共82.7%患者通过IDS达到满意的肿瘤细胞减灭效果，微创组与开腹组的术后残留病灶差异无统计学意义(P<0.05)。微创组患者的医疗费用更高(P<0.001)。两组患者的无进展生存期和总生存期差异无统计学意义(P＝0.998和P＝0.592)。结论:对于新辅助化疗(neoadjuvant chemotherapy，NACT)后行IDS的Ⅳ期卵巢癌患者，经过评估后选择微创IDS是技术上可行的手术方式，能达到满意的肿瘤细胞减灭效果，并且能减少术中出血及损伤，缩短术后恢复时间和开始化疗的时间，在一定程度上使患者获益。
Abstract
Objective:This study aimed to assess perioperative and survival outcomes of minimally invasive surgery(MIS) compared to standard laparotomy interval debulking surgery(IDS) for stage IV ovarian cancer.Methods:A retrospective study was applied in this study. All patients diagnosed with stage IV ovarian cancer who underwent IDS at the People′s Liberation Army General Hospital from Jan. 2017 to Dec. 2021 were included. According to surgical approaches, patients were divided into laparotomy(n=74) and MIS(n=24) cohorts. We collected perioperative indicators and follow-up information and then made statistical analyses to compare clinical efficacy and survival outcome.Results:The clinical baseline of IDS patients in the MIS cohort was comparable to that the open cohort. No statistical differences were observed for surgical procedures, operation time and residual diseases. Compared with the laparotomy group, the MIS group had more favorable estimated blood loss, transfusion rate, duration of postoperative recovery and adjuvant chemotherapy(above P<0.001) as well as fewer intraoperative complications (P<0.05). 82.7% of the whole were optimally cytoreductive and there was no significant difference in residual diseases(P<0.05). Nevertheless, MI-IDS patients afforded higher medical expense(P<0.001). Besides, progression-free survival and overall survival had no statistical difference(P=0.998 and 0.592, respectively).Conclusion:For stage IV ovarian cancer patients after NACT, minimally invasive IDS could represent a technically feasible alternative surgical choice with optimal cytoreduction. It could reduce intraoperative bleeding and injury, shorten postoperative recovery duration and time to chemotherapy, which benefit patients to some extent.
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