为积极响应国家卫健委“十四五”国家临床专科能力建设规划，进一步提升我国妇科肿瘤专科医师规范化诊疗水平，2026年5月22日至24日，由中国抗癌协会主办，中国抗癌协会整合妇科肿瘤委员会、浙江省抗癌协会共同承办的“2026中国抗癌协会妇科肿瘤专科医师能力建设及提升项目”在杭州举行。会议特邀韩国首尔国立大学医学院Dong Hoon Suh（徐东勋）教授作现场报告，本刊借此契机对徐东勋教授进行了专访。
编者按：为积极响应国家卫健委“十四五”国家临床专科能力建设规划，进一步提升我国妇科肿瘤专科医师规范化诊疗水平，2026年5月22日至24日，由中国抗癌协会主办，中国抗癌协会整合妇科肿瘤委员会、浙江省抗癌协会共同承办的“2026中国抗癌协会妇科肿瘤专科医师能力建设及提升项目”在杭州举行。会议特邀韩国首尔国立大学医学院Dong Hoon Suh（徐东勋）教授作现场报告，本刊借此契机对徐东勋教授进行了专访。
围绕“卵巢癌中的微创手术（MIS）应用”这一主题，徐教授指出，尽管MIS在全球卵巢癌治疗中的应用持续增长，但目前尚无高级别证据支持其作为标准术式，应严格限定其应用范围。他强调，安全始终是卵巢癌手术的首要原则，术中肿瘤溢出所导致的分期升级与不良预后无法通过术后化疗完全弥补；同时，机器人手术应用增加并不等同于其安全性已充分确立，年轻医生仍需通过导师制、规范化培训和跨机构交流以提升手术能力，积累实践经验。
《肿瘤瞭望》：近年来，MIS在妇科肿瘤领域持续发展。您如何看待微创手术在卵巢癌治疗中的作用？哪些患者适合接受这种手术方式？
徐东勋教授：首先，祝贺本次妇科肿瘤专科医师能力建设及提升项目在杭州成功举办。尽管MIS在全球临床实践中的应用呈上升趋势，但其在卵巢癌治疗中的作用有限。根据指南，目前没有任何来自随机对照试验或权威学术组织的高级别证据支持其作为标准治疗方式，因此MIS在卵巢癌治疗中的作用仍有很大的讨论空间。
具体来说，我建议将MIS在卵巢癌治疗中的应用严格限定于以下两种情况
一是早期卵巢癌，尤其是病灶仅局限于卵巢的患者。若卵巢肿块周围无明显粘连，则手术条件更为理想，可显著降低术中肿瘤破裂的风险。
二是新辅助化疗后的间歇性减瘤手术。MIS可考虑用于部分经过新辅助化疗后残留肿瘤充分缩小、能够通过MIS实现完全切除的患者。但达到上述手术指征并非易事，因此开展MIS术前，应通过诊断性腹腔镜检查以评估其可行性。
First of all, congratulations on the successful holding of this gynecologic oncology training program here. The role of MIS in ovarian cancer is still very limited. Although the use of MIS has been increasing in real-world clinical practice worldwide, I cannot say that it has become the standard approach, as its role remains open to debate. According to current guidelines, there is no recently published high-level evidence from randomized controlled trials (RCTs) or endorsed by leading academic societies to support its widespread use.
Specifically, I would limit the role of MIS in the surgical treatment of ovarian cancer. The first indication is early-stage ovarian cancer, especially when the disease is strictly confined to the ovaries. The surgical conditions are more favorable when there are no adhesions around the ovarian mass, which significantly reduces the risk of intraoperative tumor rupture. The second indication is interval debulking surgery after neoadjuvant chemotherapy, especially when the tumor has responded well to treatment and the residual disease has been sufficiently downsized to enable complete resection via MIS. However, this clinical condition is not easily achieved, even after several cycles of neoadjuvant chemotherapy. Therefore, the suitability of MIS must be confirmed by diagnostic laparoscopy before proceeding with the procedure.
《肿瘤瞭望》：与开腹手术相比，实施微创手术时确保安全性的关键考量因素有哪些？
徐东勋教授：在卵巢癌手术中，安全始终是首要原则。为了保障手术安全，我们必须非常谨慎，避免手术过程中发生肿瘤溢出。对早期卵巢癌患者实施MIS时，如果发生肿瘤溢出，可能导致肿瘤细胞播撒至整个腹腔和盆腔，使得疾病分期从预期的ⅠA期或ⅠB期升级ⅠC期，并可能使患者接受原本非必要的辅助化疗。近期发表的一项大数据报告显示，即使术后给予辅助化疗，也无法完全弥补因肿瘤溢出及分期升级所导致的不良影响。因此，开展MIS过程中必须极其谨慎，避免发生肿瘤溢出。
In ovarian cancer surgery, safety should always be the first priority. To ensure surgical safety, we must be very cautious and avoid tumor spillage during the procedure.
When MIS is performed for early-stage ovarian cancer, tumor spillage may lead to uncontrolled dissemination of tumor cells into the abdominal and pelvic cavities. This may upstage the disease from presumed stage IA or IB to stage IC, and may require the patient to receive adjuvant chemotherapy that might otherwise not have been necessary.
A recently published big-data report showed that even postoperative adjuvant chemotherapy may not fully compensate for the adverse impact caused by tumor spillage and upstaging. Therefore, when performing MIS, we must be extremely cautious to avoid tumor spillage.
《肿瘤瞭望》：基于韩国及全球的临床实践，卵巢癌微创手术领域有哪些重要经验或最新进展？
徐东勋教授：全球卵巢癌MIS的发展和应用趋势大体趋同，韩国及中国以外的其他国家并没有出现独特的进展。相关报告显示在过去10至15年间，MIS在卵巢癌手术治疗中的应用始终呈稳步增长趋势，这主要得益于机器人手术的广泛应用和普及。然而，机器人手术的应用增加并不等同于其足够安全可靠，需要谨慎解读这一全球趋势。
在韩国，相关学会已搭建起面向年轻妇科肿瘤医师的培训平台，旨在确保年轻医生能够安全地将机器人手术应用于临床，避免因外科能力不足而伤害患者。考虑到新晋医生操作经验尚有欠缺，建立规范的外科培训项目非常重要，这也是我们来到杭州参加本次项目的重要原因。
I don't think there is a special advancement in Korea or worldwide outside of China. Overall, the global trend in the development and use of MIS for ovarian cancer is largely similar. Reports have shown that over the past 10 to 15 years, the use of MIS in the surgical treatment of ovarian cancer has been steadily increasing. This is mainly due to the wider use and popularity of robotic surgery, rather than conventional laparoscopy itself. However, the increasing use of robotic surgery does not necessarily mean that it is sufficiently safe or reliable. We should interpret this global trend with caution.
In Korea, relevant academic societies have established training platforms for young gynecologic oncologists, aiming to ensure that young doctors can safely apply robotic surgery in clinical practice and avoid patient harm caused by insufficient surgical competence. Considering that junior doctors may still lack operative experience, establishing standardized surgical training programs is very important. This is also an important reason why we are here in Hangzhou.
《肿瘤瞭望》：对于年轻的妇科肿瘤医生而言，学习和实施卵巢癌微创手术时，哪些技术培训和标准最为重要？
徐东勋教授：我很难说哪一项具体的教学或培训是最重要的，但导师制无疑是核心。年轻医生跟随导师一对一学习并获取临床经验的阶段，有着不可替代的价值。此外，我们鼓励年轻医生在不同医疗机构间轮转培训，跨机构的协作模式能帮助年轻医生在有限的培训时间内快速提升专业能力，积累更多经验。
This is a very tough question. I cannot specifically point out one or two aspects of teaching or training as the most important. However, the mentoring system is essential. The attitude toward learning and gaining experience from mentors and the one-to-one learning period are very important.
Furthermore, we encourage young physicians to complete rotational training across diverse medical institutions so that they can exchange as much experience as possible. This kind of cross-institutional cooperation can help trainees become more experienced within a limited training period.
Dong Hoon Suh（徐东勋）
韩国首尔国立大学医学院
《妇科肿瘤学杂志》（Journal of Gynecologic Oncology）主编
擅长妇科内镜、不孕症、绝经相关疾病、复杂妇科腹腔镜手术、全腹腔镜子宫切除术、原发性腹腔妊娠及子宫内膜异位症等领域