Surgical Outcomes After Debulking Surgery for Intraabdominal Ovarian Growing Teratoma Syndrome: Analysis of 38 Cases
Surgical Outcomes After Debulking Surgery for Intraabdominal Ovarian Growing Teratoma Syndrome: Analysis of 38 Cases
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DOI：
10.1245/s10434-015-4608-y
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发表时间：
2015-12-01
影响因子：
3.7
通讯作者：
Gouy, Sebastien
中科院分区：
文献类型：
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作者：
Bentivegna, Enrica;Azais, Henri;Gouy, Sebastien
背景手术治疗睾丸癌后生长性畸胎瘤综合征（GTS）的目的、方法和结果已经有了很好的描述。主要的外科挑战涉及血管或胸部手术的需求。但对女性GTS知之甚少，特别是关于腹腔内疾病的最佳管理。本研究旨在评估一系列卵巢GTS的手术治疗和结局（复发率和生育力）。本研究回顾性分析了因卵巢未成熟畸胎瘤（IT）接受治疗，随后发生需要手术的腹部GTS的患者。在1983年至2014年期间，196例IT病例被转诊至作者的机构或在那里接受治疗，38例患者（19%）随后发生了GTS，包括10例腹膜胶质瘤病（仅包含纯成熟胶质组织）。诊断时的中位年龄为26岁（范围8-41岁），IT和GTS诊断之间的平均延迟为7个月（范围3-84个月）。手术切除包括腹膜切除术（n = 22）、腹膜切除术（n = 14）、肠切除术（n = 8）和脾切除术（n = 5）。20例患者可以进行保守手术。25例患者完成了肿瘤细胞减灭术。平均随访时间为73个月（范围3-263个月）。10例患者至少发生一次复发（全部为成熟疾病形式，其中8例患者进行了初始完全切除。5例患者妊娠。1例患者死于疾病并发症（肠梗阻患者肺栓塞）。腹部GTS的总体预后良好。GTS的手术程序与上皮癌减积手术中使用的程序相似。只要技术上可行，就应该进行保守手术，因为自然生育是可能的。即使在完全手术后，复发性GTS也很常见。
Background. The goal, methods, and results of surgery for growing teratoma syndrome (GTS) in men after testicular cancer have been well described. The main surgical challenge relates to the need for vascular or thoracic procedures. But little is known about GTS in women, particularly regarding the optimal management of intraabdominal disease. This study aimed to evaluate the surgical management and outcomes (recurrences and fertility) for a large series of ovarian GTS.Methods. This study retrospectively analyzed patients treated for an ovarian immature teratoma (IT) who subsequently experienced abdominal GTS requiring surgery.Results. Between 1983 and 2014, 196 cases of IT were referred to the authors' institution or treated there, and 38 patients (19 %) subsequently experienced a GTS, including 10 cases of gliomatosis peritonei (containing exclusively pure mature glial tissue). The median age at diagnosis was 26 years (range 8-41 years), and the mean delay between IT and GTS diagnosis was 7 months (range 3-84 months). Surgical resection included peritonectomy (n = 22), diaphragmatic peritoneal resection (n = 14), bowel resection (n = 8), and splenectomy (n = 5). Conservative surgery was possible for 20 patients. Complete cytoreductive surgery was achieved for 25 patients. The mean follow-up period was 73 months (range 3-263 months). At least one recurrence developed for 10 patients (in the form of mature disease in all, and 8 of these patients had an initial complete resection. Five patients had a pregnancy. One patient died of complications from the disease (pulmonary embolism in a patient with bowel obstruction).Conclusions. The overall prognosis of abdominal GTS is good. The surgical procedures for GTS are similar to those used in debulking surgery for epithelial cancer. Whenever technically possible, a conservative surgery should be performed because spontaneous fertility is possible. Recurrent GTS is frequent even after complete surgery.