大規模及大範圍手術來治療復發性婦科癌症

Exenterative surgery and recurrent and/or persistent gynecological cancers

目前針對早期癌症的最主要治療方式，就是進行手術。但是因為不同婦科癌症的特性，以及癌症的自然發展史，總有一些患者會復發或進展到晚期的癌症狀況，此時手術的角色就十分複雜，而且困難度極高。此時的手術，往往進行一些大規模及大範圍手術。骨盆腔大規模及大範圍剖除手術，就是其中的代表性手術。又可包括切除膀胱在內的前骨盆腔剖除手術，切除直腸在內的後骨盆腔剖除手術，或全部移除骨盆腔臟器的全骨盆腔剖除手術。雖然這類手術，常常伴隨極高的病發症或死亡率，不過此類手術也可能提供唯一”治癒”癌症的機會，甚至在一些高度選擇下的病患，也可因為此手術得到較佳的安寧照護，所以本期吳教授的文章，讓我們針對這個題目做一簡單的回顧。當然，對化療較有反應的癌症，例如卵巢癌，並不在此討論。

Surgery is a critical step in the management of various kinds of an early-stage gynecological cancer with lower associated morbidity and mortality. However, given the nature of the disease, these gynecologic cancers can recur or progress in some patients. The surgical management of advanced and recurrent cancers (includeing persistent or progressive cancers) is significantly more complicated, often requiring very extensive procedures. Pelvic exenterative surgery involves removal of some or all of the pelvic organs, such as for removal of urinary bladder (anterior pelvic exenteration), removal of rectum and anus (posterior pelvic exenteration) and removal of all of the pelvic organs (total pelvic exenteration). Although exenterative surgery for persistent or recurrent cancer after initial treatment is difficult and is usually associated with significant perioperative morbiddity and mortality, it provides some women with a chance of cure that otherwise may not be possible. In addition, this-type surgery may also have a role in palliation of symptoms for some carefully and highly selected patients. This brief review did not include a relatively chemotherapy-responsible tumor, such as ovarian cancer.