ileri Evre EpitelyalOver Kanserinde Lenf N odu Diseksiyonunun Sagkabma Etkisi

The effect of lymph node dissection on survival inadvanced stage epithelial ovarian cancer

Özet

Amaf: ileri evre over kanserinde pelvik ve paraaortik lenf nodu diseksiyonunun sagkalzma etkisi ve yo/ at;abilecegi olasz morbiditeler gozoniine almarak primer cerrahi yakla~zmdaki yerinin belirlenmesi Materyal ve Metod: Ocak 2000- Subat 2008 tarihleri arasmda Zeynep Kamil Kadm ve (:ocuk Hastahklarz Egitim ve Ara~tzrma Hastanesi Jinekolojik Onkoloji servisinde ameliyat edilmi~ olan 182 hastamn dosyasz retrospektif olarak incelendi. ileri evre over kanseri (evre IIIC ve evre IV) olan 31 hasta t;alz~maya dahil edildi. Cerrahi prosediirler, klinikopatolojik bulgular, gene/ ve hastalzkszz donem sagkalzm siireleri ara~tzrzldz. As it varlzgz, pozitif sitoloji, rezidiiel tumor varlzgz, histolojik tip, tiimoriin grade ve evresi bu parametrelerin sagkalzm iizerinde herhangi bir etkisinin olup olmadzgzm ara~tzrmak it;in degerlendirildi. Sonut;lar, anlamlzhk p O. 05). Lenf nodu diseksiyonu yapzlan ve yapzlmayan gruplarm gene/ ve hastalzkszz donem sagkalzm siireleri arasmda istatiksel farklzlzk gozlenmemi~tir (p>0.05). Seroz epitelyal over kanseri olgularmda gene/ sagkalzmm diger epitelyal over kanseri subtiplerine gore istatistiksel olarak anlamlz derecede yiiksek bulunmu~tur (p<0.05). Sonuf: Kesin veriler ortaya konana kadar ileri evre over kanseri alan hastalara pelvik ve paraaortik lenf nodu diseksiyonu yaparak potensiyel morbiditeyi hastalara yiiklemek mantzklz goziikmemektedir.

Abstract

Objective: To define the effect of the lymph node dissection on survival in advanced ovarian cancer and the place of the procedure in the primary surgical procedure. Materials and Methods: A total of 182 patients with epithelial ovarian carcinoma diagnosed and treated at Zeynep Kamil Hospital during January 2000- February 2008 were retrospectively reviewed Thirty-one patients with advanced stage ovarian carcinoma (stage 3C and stage 4) were included in the study. Surgical procedures, clinicopathological findings, overall and disease free survival periods of the patients, some parameters (ascites, positive cytology, residual tumor, hystology, grade, stage) which might have some effect on survival were evaluated Statistical analysis was performed with independent t and chi-square tests. Differences were considered statistically significant at a probability value of <0.05. The Kaplan-Meier test was used to estimate the survival and log rank test was used to estimate the factors affecting survival. Results: There was no significant difference between the groups with and without lymph node dissection with respect to the median operation time, rate of intraoperative blood transfusion, amount of intraoperative bleeding, complication rates, postoperative stay in hospital, recurrences and deaths (p>O. 05). No significant difference was observed in overall and disease free survival between groups (p>0.05). The overall survival of the serous epithelial ovarian cancer was significantly higher than the non-serous epithelial ovarian cancer (p=0.002). Conclusion: Until definitive data exist, it does not seem logical to inflict the potential morbidity of a lymph node dissection on a patient with palpably normal retroperitoneal nodes in an attempt to by chance detect microscopic tumor deposits.