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Qual o melhor momento da cirurgia no câncer epitelial de ovário?
Dr. Bruno SarmentoHospital de Base do Distrito Federal
Cirurgia Oncológica
Câncer de Ovário: Cirurgia de estadiamento
N Engl J Med 1976 Apr 8;294(15):818–822
1. Histerectomia total
2. Anexetomia bilateral
3. Linfadenetctomias pélvicas e retroperitoneais
4. Omentectomia infragástrica
5. Biópsia peritoneais
6. Citologia peritoneal
Câncer de Ovário: Guideline NCCN
Stage IA or IB
Grade 3
Grade 2
Grade 1
IV Chemo
Observe orIV Chemo
Observe
Stage IC 1,2 or 3 IV Chemo
Stage II, III or IVIP ChemoIV Chemo
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#ovarian
Qualidade da Cirurgia de Estadiamento
1. Ótimo: avaliação da cavidade, biópsias das lesõe suspeitas,
biópsias às cegas, lavado peritoneal, omentectomia,
estudo dos linfonodos pélvicos e retroperitoneais
2. Modificado: conduta intermediária.
3. Mínima: avaliação da cacidade, biópsias das lesões, lavado
peritoneal e omentectomia.
4. Inadequada: inspeção e biópsia de lesões suspeitas.
J Natl Cancer Inst 2003;95:113–25
Câncer de Ovário: Estadiamento Incompleto
The benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma
Gynecologic Oncology 85, 351–355 (2002)
Câncer de Ovário: Estadiamento Incompleto
The benefits of comprehensive surgical staging in the management of early-stage epithelial ovarian carcinoma
Gynecologic Oncology 85, 351–355 (2002)
Seguimento mediano 58 meses:
Recorrência em 23% dos pacientes
Recorrência I (adequado): 10%
Recorrência I (inadequado): 28% (p=0.036)
Pacientes estadio I 36% upstaged para II ou III.
Todas foram micrometástases. Sem fatores adversos.
Impact of Adjuvant Chemotherapy and Surgical Staging in Early-Stage Ovarian Carcinoma: European Organisation for Research and Treatment of Cancer–Adjuvant ChemoTherapy in Ovarian Neoplasm Trial.
Câncer de Ovário: Estadios Inicais (I)
J Natl Cancer Inst 2003;95:113–25
Impact of Adjuvant Chemotherapy and Surgical Staging in Early-Stage Ovarian Carcinoma: European Organisation for Research and Treatment of Cancer–Adjuvant ChemoTherapy in Ovarian Neoplasm Trial.
Câncer de Ovário: Estadios Inicais (I)
J Natl Cancer Inst 2003;95:113–25
Impact of Adjuvant Chemotherapy and Surgical Staging in Early-Stage Ovarian Carcinoma: European Organisation for Research and Treatment of Cancer–Adjuvant ChemoTherapy in Ovarian Neoplasm Trial.
Câncer de Ovário: Estadios Inicais e Quimioterapia
J Natl Cancer Inst 2003;95:113–25
Impact of Adjuvant Chemotherapy and Surgical Staging in Early-Stage Ovarian Carcinoma: European Organisation for Research and Treatment of Cancer–Adjuvant ChemoTherapy in Ovarian Neoplasm Trial.
Câncer de Ovário: Estadios Inicais e Observação
J Natl Cancer Inst 2003;95:113–25
Recomendação: Estadiamento Inicial IncompletoQuando operar?
Estadio IA or IBGrau 2
Quimioterapia
Observar
QT Reoperação
Reoperação
Estadio I grau 3Estadio II
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#ovarian
Quimioterapia QT Reoperação
Estadio IA or IBGrau 1
Multivisceral cytoreductive surgery in FIGO stages IIIC and IV epithelial ovarian cancer: Results and 5-year follow-up
Gynecologic Oncology 106 (2007) 591–595.
Multivisceral cytoreductive surgery in FIGO stages IIIC and IV epithelial ovarian cancer: Results and 5-year follow-up
Gynecologic Oncology 106 (2007) 591–595.
Multivisceral cytoreductive surgery in FIGO stages IIIC and IV epithelial ovarian cancer: Results and 5-year follow-up
Gynecologic Oncology 106 (2007) 591–595.
Identification of patient groups at highest risk from traditional approach to ovarian cancer treatment
Gynecologic Oncology 120 (2011) 23–28
Critérios Radiológicos Preditores de Citorredução Incompleta
1. Massa epigástrica > 5cm
2. Múltiplos pontos de obtrução intestinal
3. Distorção do mesentério
4. Hidronefrose
5. Icterícia obstrutiva
Cancer 2005;103:839–49.
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer
N Engl J Med 2010;363:943-53.
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer
N Engl J Med 2010;363:943-53.
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer
N Engl J Med 2010;363:943-53.
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer
N Engl J Med 2010;363:943-53.
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer
N Engl J Med 2010;363:943-53.
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer
N Engl J Med 2010;363:943-53.
N Engl J Med 2010;363:943-53.
Neoadjuvant Chemotherapy or Primary Surgery in Stage IIIC or IV Ovarian Cancer
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