Research Article
Rekürren over kanseri hastalarında uygulanan tersiyer ve kuaterner sitoredüksiyon cerrahilerinin sağ kalıma etkisi ve morbiditesi
Abstract
Amaç: Rekürren over kanseri hastalarında uygulanan tersiyer ve kuaterner sitoredüktif cerrahilerin sağ kalım ve morbidite sonuçlarının incelenmesidir.
Gereç ve Yöntem: Hasta kayıtları retrospektif olarak incelenmiştir. Sağ kalım oranlarının tespitinde Kaplan-Meier sağ kalım analizi ve karşılaştırmalar için log-rank testleri kullanılmıştır. Tüm analizlerde anlamlı istatistiki değer p:<0,05 olarak kabul edilmiştir.
Bulgular: Çalışmaya Şubat 2007-2012 tarihleri arasında rekürren over kanseri tanısı ile takip edilen 106 hasta dahil edildi. İkinci rekürrens nedeniyle 47 hastaya tersiyer, 3. rekürrens nedeniyle 12 hastaya kuaterner sitoredüksiyon uygulandı. Ortalama tanı yaşı 54,1±11,2; ortanca takip süresi 40 ay idi. Ortalama ve ortanca sağ kalım süreleri sırasıyla 66,5 ± 5,1 ve 56 ay idi. İkinci rekürrens sonrası tersiyer sitoredüksiyon yapılan hastaların sağ kalımı, yalnızca kemoterapi verilen hastalardan anlamlı olarak uzundu (73,8±7,3 vs 52,0±5,6 ay) (p:0,039). Tersiyer sitoredüksiyon hastalarında, platin duyarlı olanların sağ kalım süresi dirençli olanlardan daha uzun olarak tespit edildi (78,8±8,2 vs 44,4±6,4 ay) (p:0,121). Üçüncü rekürrens sonrası kuaterner sitoredüksiyon yapılan ve yapılmayan hastaların sağ kalım sürelerinin ise benzer olduğu görüldü (63,7±7,5; 62,7±8,3 ay) (p:0,616). Tersiyer ve kuaterner sitoredüksiyonlarda intraoperatif komplikasyon oranı %15; postoperatif komplikasyon oranı ise %20-25 idi. Cerrahi sonrası yoğun bakım ihtiyacı; tersiyer ve kuaterner sitoredüksiyonlar sonrası primer ve sekonder sitoredüksiyonlardan daha fazla idi (p:<0,0001).
Sonuç: Rekürren over kanseri hastalarında, tersiyer sitoredüksiyonun sağ kalım üzerine olumlu etkisi olabilir. Tersiyer ve kuaterner sitoredüksiyon cerrahileri sonrasında yoğun bakım ihtiyacının primer ve sekonder sitoredüktif cerrahilerden daha fazla olması; bu geniş cerrahilerin deneyimli merkezlerde gerçekleştirilmesini zorunlu kılmaktadır.
References
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Year 2021,
Volume: 60 Issue: 1, 20 - 31, 31.03.2021
Abstract
References
- Bristow RE. Surgical standards in the management of ovarian cancer. Curr Opin Oncol Sep 2000; 12 (5): 474–80.
- Chi DS, Franklin CC, Levine DA et al. Improved optimal cytoreduction rates for stages IIIC and IV epithelial ovarian, fallopian tube and primary peritoneal cancer: a change in surgical approach. Women’s Oncol Rev 2004; 4, (4): 263–4.
- du Bois A, Reuss A, Pujade-Lauraine E, Harter P, Ray-Coquard I, and Pfisterer J. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer: A combined exploratory analysis of 3 prospectively randomized phase 3 multicenter trials.Cancer 2009; 115 (6): 1234–44.
- Kapp KS,Kapp DS, Poschauko J et al. The prognostic significance of peritoneal seeding and size of postsurgical residual in patients with stage III epithelial ovarian cancer treated with surgery, chemotherapy, and high-dose radiotherapy. Gynecol Oncol 1999; 74 (3): 400–7.
- Harter P, Muallem ZM, Buhrmann C et al. Impact of a structured quality management program on surgical outcome in primary advanced ovarian cancer. Gynecol Oncol 2011;121 (3): 615–9.
- Muggia FM, Braly PS, Brady MF et al. Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: A Gynecologic Oncology Group study. J Clin Oncol 2000; 18 (1): 106–15.
- Zang RY, Zhang ZY, Li ZT et al. Impact of secondary cytoreductive surgery on survival of patients with advanced epithelial ovarian cancer. Eur J Surg Oncol 2000, 26 (8): 798–804.
- Zang RY, Li ZT, Tang J et al. Secondary Cytoreductive Surgery for Patients with Relapsed Epithelial Ovarian Carcinoma: Who Benefits? Cancer 2004; 100 (6): 1152–61.
- Ayhan A,Gultekin M, Taskiran C et al. The role of secondary cytoreduction in the treatment of ovarian cancer: Hacettepe University experience. Am J Obstet Gynecol 2006; 194 (1): 49–56.
- Bristow RE, Puri I and Chi DS. Cytoreductive surgery for recurrent ovarian cancer: A meta-analysis. Gynecol Oncol 2009; 112 (1): 265–74.
- Onda T, Yoshikawa H, Yasugi T, Yamada M, Matsumoto K, and Taketani Y. Secondary cytoreductive surgery for recurrent epithelial ovarian carcinoma: Proposal for patients selection. Br J Cancer 2005; 92 (6): 1026–32.
- Chi DS, McCaughty K, Diaz JP et al. Guidelines and selection criteria for secondary cytoreductive surgery in patients with recurrent, platinum-sensitive epithelial ovarian carcinoma. Cancer 2006; 106 (9): 1933–9.
- Bickell NA, Egorova N, Prasad-Hayes M et al. Secondary Surgery Versus Chemotherapy for Recurrent Ovarian Cancer. Am J Clin Oncol Cancer Clin Trials 2018; 41 (5): 458–64.
- Coleman RL, Spirtos NM, Enserro D et al. Secondary surgical cytoreduction for recurrent ovarian cancer. N Engl J Med 2019; 381 (20): 1929–39.
- Fanfani F, Fagotti A, Ercoli A et al. Is There a Role for Tertiary (TCR) and Quaternary (QCR) Cytoreduction in Recurrent Ovarian Cancer? Anticancer Res 2015; 35 (12): 6951–5.
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- Arvas M, Salihoglu Y, Sal V et al. Tertiary cytoreduction for recurrent epithelial ovarian cancer: A multicenter study in Turkey. Asian Pacific J Cancer Prev 2016; 17 (4): 1909–15.
- Shih KK, Chi DS, Barakat RR, and Leitao Jr MM. Beyond Tertiary Cytoreduction in Patients With Recurrent Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer. Gynecol Oncol 2010, 116 (3): 364-9.Cilt 60 Sayı 1, Mart 2021 / Volume 60 Issue 1, March 2021 31
- Fotopoulou C, Zang R, Gultekin M et al. Value of tertiary cytoreductive surgery in epithelial ovarian cancer: An international multicenter evaluation. Annals of Surgical Oncology 2013; 20 (4): 1348–54.
- Fotopoulou C,Savvatis K,Kosian P et al. Quaternary cytoreductive surgery in ovarian cancer: Does surgical effort still matter. Br J Cancer 2013; 108 (1): 32–8.
- Falcone F, Scambia C, Benedetti Panici P et al. Tertiary cytoreductive surgery in recurrent epithelial ovarian cancer: A multicentre MITO retrospective study. Gynecol Oncol 2017; 147 (1): 66–72.
- Hirakawa T, Minaguchi T, Itani Y et al. Current status of tertiary debulking surgery and prognosis after secondary debulking surgery for recurrent müllerian epithelial cancer in Japan: a retrospective analysis of 164 patients (KCOG-G1402). World Journal of Surgical Oncology 2017; 15 (132): 1-7
- Bacalbasa N, Balescu I, Vilcu M, Dima S and Brezean I. Upper abdominal resection as part of tertiary cytoreduction for relapsed ovarian cancer. In Vivo 2020; 34 (1): 407-11
- Dogan NU, Schneider A, Chiantera V, Dogan S, and Dursun P. Tertiary cytoreduction in the setting of recurrent ovarian cancer (Review). Oncol Lett 2013; 6 (3): 642–7.
- Karam AK, Santillan A, Bristow RE et al. Tertiary cytoreductive surgery in recurrent ovarian cancer: Selection criteria and survival outcome. Gynecol Oncol 2007; 104 (2): 377–80.
- Bacalbasa N, Balescu I, Dima S,Brasoveanu V,Popescu I. The role of quaternary cytoreduction in recurrent epithelial ovarian cancer: a single center experience. Anticancer Res 2015; 35 (6): 3519-23.
There are 26 citations in total.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 31, 2021 |
| Submission Date | May 12, 2020 |
| Published in Issue | Year 2021Volume: 60 Issue: 1 |
