The Role of Surgery in the Treatment of Ovarian Cancer
KF Tam
Hong Kong J Radiol 2011;14(Suppl):S19-23
Most patients with ovarian cancer undergo surgery at some point during the course of their treatment. A primary operation may be undertaken for the purpose of confirming the diagnosis, staging, and debulking. Numerous publications have documented the importance of proper staging in ovarian cancer, which determines the treatment plan — including whether chemotherapy is indicated — and therefore impacts substantially on patient outcomes and survival. Improper staging can lead to underestimation of the extent of the disease and undertreatment. For patients with advanced disease, complete debulking surgery improves survival significantly. If patients are not suitable for primary debulking however, neoadjuvant chemotherapy should be considered. There remains uncertainty surrounding the role and effectiveness of interval debulking surgery as opposed to standard of primary debulking surgery in the course of first-line treatment of advanced ovarian carcinoma. More evidence is needed before a conclusion can be drawn about this issue. Surgery is not limited to primary treatment, but may also be indicated for patients with recurrent ovarian cancer or to provide palliative care and symptom relief for patients who are at the end stages of the disease.
中文摘要
手術在治療卵巢癌中的角色
譚家輝
大部份卵巢癌患者會在治療過程中接受手術治療。為要進行病情確診、分期及減瘤，患者會進行初 次手術。文獻中大量記載了為卵巢癌適當分期的重要性，因為分期決定治療計劃，包括是否需要化 療，繼而會大大影響治療結果及患者生存期。分期不當會低估病情及引致不恰當的治療。至於患有 晚期卵巢癌的患者，完全減瘤術可以大大提高其存活期。如果患者不適合接受初次減瘤術，可考慮 引導化療。對於晚期卵巢癌的一線治療應該進行間隔減瘤術還是標準的初次減瘤術,文獻對於這兩種 方法的角色及效用都未有定案，因此必須要有更多實證才能下定論。事實上，手術並非只限於卵巢 癌的初次治療，亦適用於一些復發性的卵巢癌患者。在已進入晚期卵巢癌的患者來說，手術也可以 提供緩解治療及起症狀緩解的作用。