Современная онкология (Dec 2018)
A method of laparoscopic installation of port systems for intra-abdominal chemotherapy in patients with advanced ovarian cancer
Abstract
Ovarian cancer is one of the leading causes of death in the world, in 80% of cases the diagnosis is made at a late stage. In 50% of cases, a relapse occurs even after the optimal treatment has been performed. The initial treatment of ovarian cancer, regardless of the stage of the tumor process, begins with surgical treatment, and at the second stage, combined chemotherapy is performed. Since the tumor process in ovarian cancer, as a rule, local, limited in the abdominal cavity, in order to reduce the toxicity of chemotherapy drugs on the body as a whole, the alternative options for the administration of chemotherapy drugs is intra-abdominal, which allows increasing the concentration of the drug directly in the tumor locus. Purpose of research. In our study, we want to describe the laparoscopic method of placement of intra-abdominal port systems, assess the disadvantages and advantages, as well as the risks of complications in the case of port installation at the first stage of treatment (intraoperative port installation during laparotomy) and at stage 2 (laparoscopic). Materials and methods. Technically, the implantation of the intraperitoneal port system in order to carry out subsequent chemotherapy courses was carried out in two ways: 1) intraoperative; 2) laparoscopic approaches. In the first case, the installation is carried out directly after the implementation and evaluation of the surgical intervention. In the second, the intraperitoneal catheter is implanted with laparoscopic access after revision and assessment of the quality of cytoreductive surgery. The study included 77 patients with ovarian cancer stage Ic-IV, who underwent optimal cytoreduction at the first stage of treatment (residual tumor up to 1 cm in diameter). At the second stage of treatment, patients were planned to undergo intra-abdominal chemotherapy with palixaxel drugs in combination with intravenous cisplatin. Port systems in 56 cases (72.7%) were installed intraoperatively and in 21 cases (27.3%) laparoscopically. Results. In total, port systems were installed in 77 patients, of which - in 56 cases intraoperatively and in 21 cases laparoscopically. However, a total of 30 (38.9%) laparoscopic interventions were performed: in 21 (27.2%) cases a port system was installed, in 6 (7.8%) cases during laparoscopy contraindications were detected for port implantation, in 3 (3.9%) cases required a reinstallation of the port system due to complications arising after intraoperative implantation. As described above, 6 patients had contraindications for installing port systems, of which in 4 (5.2%) cases, it turned out to be a marked adhesive disease after primary cytoreduction, in two patients (2.6%) non-optimal amount of cytoreductive interventions in the first stage. Multiple metastases in the peritoneum of up to 3 cm in diameter were visualized in one patient, which did not correspond to the protocol of the operation, the patient subsequently received standard treatment; in the second case, there was a large omentum with metastatic lesions. The patient was re-operated in the optimal volume and intraperitoneal intraperitoneal port system was installed intraoperatively. Thus, in 7.8% of cases, the protocol data of the operation did not match the laparoscopic data. Conclusion. The method of laparoscopic implantation of intra-abdominal port systems is safe and effective, which in comparison with the intraoperative installation method provides several advantages: additional revision of the abdominal cavity to assess the optimality of cytoreductive surgery performed at the first stage, assessment of the degree of adhesions in the abdominal cavity, which in turn affects the uniform distribution of the drug.
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