Miniinvasive surgical intervention in diagnostic and treatment of the patients with ovarian malignant tumour of stage iv

Full Text

A laparoscopy methods have more and more importance in treatment of the patients with malignant tumors of women reproductive system.

The purpose of research - to estimate an opportunity and expediency of application diagnostic laparoscopy at the patients with stage IV of ovarian malignant tumor.

Object and methods of research. The cogort research included patients whith malignant tumors of ovary, who were treated in MMCH by name N.N. Burdenko since 01.01.1988 till 01.06.05. 80 (23%) patients had stage IV of disease. 77 patients had epithelial tumors, 3 - not epithelial. The treatment was begun from attempt of cytoreductive operation in 50 patients; diagnostic laparoscopy with biopsy of a tumor with subsequent neoaduvant chemotherapy and cytoreductive operation were done in 22. 8 patients were executed a laparocentes with an evacuation of liquid and subsequent induction of chemotherapy or combined treatment. The criteria of an estimation of efficiency of a method were volume of cytoreductive operation, the time before the beginning of antitumour treatment. The statistical processing of results was carried out by not parametrical methods with account of average, relative sizes, exact criteria Fisher and Mann-Whitney.

Results of research. In group of the patients, where the treatment was begun from laparotomy the cytoreductive operation were performed in 33 (66%), and 17 patients (34%) was underwent an explorative laparotomy due to technical difficulties. In group of the patients, where the treatment was begun from diagnostic laparoscopy with subsequent neoaduvant chemotherapy all 22 (100%) patient were underwent by cytoreductive operations (p < by 0,05 between groups). The time before the beginning of antitumour therapy was 7,8 ± 1,2 days in group of the patients, where the treatment was begun from laparotomy. In group of the patients, where the treatment was begun from diagnostic laparoscopy the period before an antitumour therapy was 4,8 + 1,1 days (p < 0,05 between groups). In one patient with malignant germ cell tumor, who was underwent laparocentes neoduvant chemotherapy was performed not in standart protocol because of inconsistent cytologic data. In group of the patients, where diagnostic laparoscopy with biopsy of a tumour were carried out all patients were treated on the standard protocol. There were no complications at realization of diagnostic laparoscopy with biopsy of a tumor.

Conclusions. 1. Diagnostic laparoscopy with biopsy of a tumor is an effective method allowing to estimate the possibility of patients with stage IV of ovarian malignant tumors to be operated; also, this method allows to define the histological type of a tumor and to choose an adequate program of chemotherapy.

2. At realization of diagnostic laparoscopy in comparison with laparotomy in the patients with stage IV of malignant tumors of ovary reduces the period prior to the beginning of antitumour treatment.

About the authors

A. I. Меl՚ко

National medical-surgical centre named after N.I. Pirogov of the Ministry of Health of the Russian Federation, GIPED MD

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Moscow

Е. F. Kira

National medical-surgical centre named after N.I. Pirogov of the Ministry of Health of the Russian Federation, GIPED MD

Email: info@eco-vector.com
Russian Federation, Moscow

I. I. Ushakov

National medical-surgical centre named after N.I. Pirogov of the Ministry of Health of the Russian Federation, GIPED MD

Email: info@eco-vector.com
Russian Federation, Moscow

I. I. Ermolinskiy

National medical-surgical centre named after N.I. Pirogov of the Ministry of Health of the Russian Federation, GIPED MD

Email: info@eco-vector.com
Russian Federation, Moscow

I. P. Zarubenko

National medical-surgical centre named after N.I. Pirogov of the Ministry of Health of the Russian Federation, GIPED MD

Email: info@eco-vector.com
Russian Federation, Moscow

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