對晚期卵巢癌行淋巴結摘除的檢視

The role of lymphadenectomy for advance ovarian cancer patients

傳統上，卵巢癌的減積手術包括全子宮切除、兩側輸卵管卵巢切除、大網膜切除、骨盆腔和主動脈旁切除，但近幾年來，後腹膜淋巴結摘除術在治療上的效果受到質疑，認為摘除只是為了癌症的分期，對治療助益不大。如果摘除淋巴結無臨床上好處，且會增加血管和輸尿管受傷、淋巴囊腫生成、肺栓塞等風險，甚至是術後死亡率，就應該重新評估。

Traditionally, cytoreductive surgery for advanced ovarian cancer include total hysterectomy, bilateral salpingo-oophorectomy and infragastric omentectomy as well as systematic pelvic and para-aortic lymphadenectomy. However, during the last decade, the role of retroperitoneal lymphadenectomy for therapeutic purpose has been questioned. The core issue of the controversy is whether the removal of lymph nodes should be performed only to stage the disease or if the removal itself improves survival. In addition, several studies have shown that systematic lymphadenectomy is associated with a risk of vascular injury, ureter injury, lymph cyst formation, pulmonary embolism and even increased post-operative mottality. We present an extensive review of the available literature on the matter, hoping to provide some insight into the true need for such a procedure.