Abstract

Debulking surgery, also called cytoreductive surgery, is a resection of the tumor as much as possible and an intended incomplete resection for unresectable malignant tumors. Since the most important principle in surgical oncology is complete R0 resection, debulking surgery goes against the basic principle and obscures the concept of operability. However, debulking surgery has been advocated for various types of advanced malignant tumors, including gynecological cancers, urological cancers, gastrointestinal cancers, breast cancers and other malignancies, with or without adjuvant therapy. Positive data from randomized trials have been shown in subsets of ovarian cancer, renal cell carcinoma, colorectal cancer and breast cancer. However, recent trials for renal cell carcinoma, colorectal cancer and breast cancer have tended to show controversial results, mainly according to the survival improvement of nonsurgical systemic therapy alone. On the other hand, debulking surgery still has a therapeutic role for slow-growing and borderline malignant tumors, such as pseudomyxoma peritonei and thymomas. The recent understanding of tumor heterogeneity and clonal evolution responsible for malignancy and drug resistance indicates that select patients may obtain prolonged survival by the synergistic effect of debulking surgery and novel systemic therapy. This review aimed to describe the current status and evidence of debulking surgery in a cross-organ manner and to discuss future perspectives in the current era with advances in systemic therapy.

中文翻译：

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恶性肿瘤减瘤手术：现状、证据和未来展望

摘要

减瘤手术，也称为减瘤手术，是对肿瘤进行尽可能多的切除，对无法切除的恶性肿瘤进行拟不完全切除。由于肿瘤外科最重要的原则是完全R0切除，减瘤手术违背了基本原则，模糊了可操作性的概念。然而，对于各种类型的晚期恶性肿瘤，包括妇科肿瘤、泌尿系统肿瘤、胃肠道肿瘤、乳腺癌和其他恶性肿瘤，无论是否有辅助治疗，都提倡减瘤手术。随机试验的阳性数据已在卵巢癌、肾细胞癌、结直肠癌和乳腺癌的亚组中显示出来。然而，最近的肾细胞癌试验，结直肠癌和乳腺癌往往表现出有争议的结果，主要是根据非手术全身治疗的生存改善。另一方面，减瘤手术对于生长缓慢和交界性的恶性肿瘤，如腹膜假粘液瘤和胸腺瘤，仍有治疗作用。最近对导致恶性肿瘤和耐药性的肿瘤异质性和克隆进化的理解表明，通过减瘤手术和新型全身治疗的协同作用，特定患者可以获得延长的生存期。本综述旨在描述跨器官减瘤手术的现状和证据，并讨论当前随着全身治疗进展的时代的未来前景。另一方面，减瘤手术对于生长缓慢和交界性的恶性肿瘤，如腹膜假粘液瘤和胸腺瘤，仍有治疗作用。最近对导致恶性肿瘤和耐药性的肿瘤异质性和克隆进化的理解表明，通过减瘤手术和新型全身治疗的协同作用，特定患者可以获得延长的生存期。本综述旨在描述跨器官减瘤手术的现状和证据，并讨论当前随着全身治疗进展的时代的未来前景。另一方面，减瘤手术对于生长缓慢和交界性的恶性肿瘤，如腹膜假粘液瘤和胸腺瘤，仍有治疗作用。最近对导致恶性肿瘤和耐药性的肿瘤异质性和克隆进化的理解表明，通过减瘤手术和新型全身治疗的协同作用，特定患者可以获得延长的生存期。本综述旨在描述跨器官减瘤手术的现状和证据，并讨论当前随着全身治疗进展的时代的未来前景。最近对导致恶性肿瘤和耐药性的肿瘤异质性和克隆进化的理解表明，通过减瘤手术和新型全身治疗的协同作用，特定患者可以获得延长的生存期。本综述旨在描述跨器官减瘤手术的现状和证据，并讨论当前随着全身治疗进展的时代的未来前景。最近对导致恶性肿瘤和耐药性的肿瘤异质性和克隆进化的理解表明，通过减瘤手术和新型全身治疗的协同作用，特定患者可以获得延长的生存期。本综述旨在描述跨器官减瘤手术的现状和证据，并讨论当前随着全身治疗进展的时代的未来前景。