Предикторы циторедукции: лапароскопическая диагностика для выбора тактики лечения у пациенток с распространенными формами серозного рака яичников

Abstract

Ovarian cancer (OC) holds the first place in a structure of mortality among oncogynecology diseases all over the world. Complex approach in treatment of advanced forms of serous ovarian cancer (SOC) (stages III-IV by FIGO) – suggests a combination of surgery and chemotherapy methods – as the world standard. Nowadays, use of operative intervention at the preliminary stage of treatment (primary cytoreduction) is regarded as preferred and contributes to remote therapy results in women, if compared to those patients whose treatment started with the courses of neoajuvant chemotherapy. Nevertheless, just volume of residual tumor belongs to the most important predictive factors in patients with SOC, therefore, depth of cytoreductive surgery completion is considered to be a mainstay in treatment of such women. Macroscopic absence of residual tumor – its full cytoreduction is referred to as the «gold standard» in surgery treatment of OC. At present, there are no efficient methods which would allow to predict a full extent of cytoreduction and, as a result, to identify the group of patients with justified neoajuvant chemotherapy and the next cytoreduction in intervals, as well as women who will benefit from performing primary cytoreduction. Diagnostic laparoscopy for assessment of tumor process spreading and predicting the volume of cytoreduction was first time conducted in 1998. Until presently, only 1 randomized study (the Netherlands, 2016) had been carried out with participation of 201 women to evaluate effectiveness of diagnostic laparoscopy as a predictive factor of cytoreduction. The other studies were conducted as non-randomized pro– and retrospective. Review of literature proposed in the article allows introducing the data and all results of such studies. Use of laparoscopy as the predictor of cytoreduction in combination with radiology diagnostic methods allows making much personalized approaches in therapy of women with advanced forms of SOC and therefore, will contribute to better remote results of treatment. Key words: serous ovarian cancer, diagnostic laparoscopy, cytoreductive surgery.