목적: 진행된 부인암 환자들에서 optimal 종양감축술을 시행한 군과 suboptimal 종양감축술을 시행한 군간의 효율 (efficacy)과 이환율 (morbidity)을 비교하고, optimal 종양감축술 시행에 제한적인 요소들을 알아보고자 하였다. 연구 방법: 1998년부터 2003년까지 가천의대 길병원 산부인과에서 32명의 난소암환자, 4명의 난관암환자, 3명의 원발성 복막암 환자에서 종양감축술을 시행하였다. 이들 중 38명은 FIGO Stage IIIC로 진단되었고, 1명만이 FIGO Stage IV에 해당하였다. 의무기록을 통해 환자의 특성, 수술과 관련된 특성, 수술시간, 실혈량, 수혈 정도, optimal 종양감축술이 시행되지 못한 이유들을 후향적으로 검토하였다. 결과: Mean follow-up 기간은 23개월이었고, 1개월부터 62개월까지 분포되었으며, optimal 종양감축술이 25명의 환자에서 시행되었다 (64.1%). 다변량 분석결과, 수술 후 잔류 종양의 크기는 생존율과 무병기간에서 가장 중요한 예후인자로 나타났다. optimal 군의 2년 생존율은 86.5%였고, suboptimal 군은 41.3%였으며, 두 군간의 생존율 차이는 통계학적으로 유의성을 보였다 (p=0.0153). 2년 무병생존율은 각각의 군에서 75.9%와 7.1%였으며, 두 군간의 무병생존율 차이도 통계학적으로 유의성을 나타냈다 (p=0.0003). Suboptimal 수술의 주요한 원인으로는 69세 이상의 고령, 심장질환, 수술 중 불안정한 생체징후, 기관지 확장증 등의 의학적 문제들과 여러 장기 절제술에 대한 보호자의 동의 거부, 수술 중 장간막 기저부의 침윤이나 광범위한 소장 침윤이 발견된 경우 등이 있었다. 결론: Optimal 종양감축술은 임상적 문제점이 없고 절제불가능한 위치에 병변이 침윤되어 있지만 않는다면 가능하며, 수술 후 합병증도 suboptimal 종양감축술을 시행한 경우와 큰 차이를 보이지 않았고, 더 좋은 예후를 보였다. 따라서 복막 파종을 유발하는 진행된 부인암 환자에서 장 절제술, 복막 절제술, 비장 적출술 등을 포함한 근치적 수술이 optimal 종양감축술을 위해 고려되어야 할 것으로 생각되고, optimal 종양감축술이 시행될 경우 생존율과 무병생존율의 향상을 기대할 수 있으며, 환자나 보호자의 적극적인 치료의지도 중요한 인자로 나타나 치료자의 보다 더 적극적인 설명과 설득이 필요할 것으로 생각된다.

Objective: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. Methods: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. Results: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. Conclusion: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.

Objective: The aims of this study were to compare the efficacy and morbidity of optimal debulking operation with those of suboptimal operation for patients with advanced gynecologic malignancies and to establish the precluding factors for performing the optimal cytoreductive surgery. Methods: From January 1998 to December 2003, debulking operation for advanced gynecologic malignancy was performed in thirty-nine patients with ovarian cancer (32), tubal cancer (4), and primary peritoneal carcinoma (3) at the department of obstetrics and gynecology, Ghil Medical Center. Of them, 38 patients had FIGO Stage IIIC disease and only one patient had FIGO Stage IV disease. Most informations were obtained by hospital records and were analyzed retrospectively. Results: The mean follow-up was 23 months (range, 1-62 months). The optimal debulking operation could be performed in 25 patients (64.1%). In multivariate analysis, the largest diameter of residual tumor was the most important prognostic factor. Two-year overall survival rate of optimally debulked patients was 86.5% and that of suboptimally debulked patients was 41.3% (p=0.015). Two-year disease free survival rates were 75.9% and 7.1%, respectively (p=0.0003). Complication rates associated with surgery were 40% in optimally debulked patients and 35.7% in suboptimally debulked patients (p=0.083). Major causes of suboptimal surgery were old age (>69 yrs), poor medical condition (cardiac problem, intraoperative unstable vital sign, bronchiectasis), no submission of permission, and involvement of the base of mesentery and small bowel. Conclusion: Optimal debulking operation is possible if there were no significant clinical problem and involvement of base of mesentery and small bowel. It appears acceptable surgical morbidity and better prognosis. Therefore, the surgeon should use every technique aimed at removing the tumor as much as possible.

Gynecologic malignancies, Peritoneal dissemination, Optimal cytoreductive surgery