Sugarbaker P H
Washington Cancer Institute, Washington Hospital Center, DC 20010, USA.
Jpn J Clin Oncol. 2001 Dec;31(12):573-83. doi: 10.1093/jjco/hye088.
Peritoneal surface malignancy can result from seeding of gastrointestinal cancer or abdomino-pelvic sarcoma; it can also occur as a primary disease, such as peritoneal mesothelioma. In the past, this clinical situation was treated only with palliative intent.
An aggressive approach to peritoneal surface malignancy involves peritonectomy procedures, perioperative intraperitoneal chemotherapy and knowledgeable patient selection. The clinical assessments necessary for valid clinical judgements include the cancer histopathology (invasive vs expansive progression), the preoperative abdominal and pelvic CT, the peritoneal cancer index and the completeness of cytoreduction score. Proper patient selection is mandatory for optimizing the results of treatment.
In a series of phase II studies, appendiceal tumors with peritoneal seeding became the paradigm for success with an 85% long-term survival in selected patients. Carcinomatosis from colon cancer had an overall 5-year survival of 50% with selected patients. Also, sarcomatosis patients overall had a 40% 5-year survival in selected patients. Peritoneal mesothelioma showed a 36% 5-year survival. In all malignancies, early aggressive treatment of minimal peritoneal surface dissemination showed the greatest benefit.
Oncologists must accept responsibility for knowledgeable management of peritoneal surface dissemination of cancer because a curative approach has been demonstrated in large phase II studies and all historical controls show 0% long-term survival. Adjuvant phase III studies with perioperative intraperitoneal chemotherapy in diseases where peritoneal surface spread occurs are indicated.
腹膜表面恶性肿瘤可由胃肠道癌或腹盆腔肉瘤种植引起；也可作为原发性疾病出现，如腹膜间皮瘤。过去，这种临床情况仅采用姑息性治疗。
对腹膜表面恶性肿瘤采取积极的治疗方法包括腹膜切除术、围手术期腹腔内化疗以及合理的患者选择。进行有效临床判断所需的临床评估包括癌症组织病理学（浸润性与膨胀性进展）、术前腹部和盆腔CT、腹膜癌指数以及肿瘤细胞减灭评分的完整性。为优化治疗效果，必须进行合理的患者选择。
在一系列II期研究中，伴有腹膜种植的阑尾肿瘤成为成功范例，部分患者长期生存率达85%。结肠癌种植转移患者总体5年生存率为50%，部分患者生存率更高。同样，肉瘤种植转移患者部分患者5年生存率为40%。腹膜间皮瘤5年生存率为36%。在所有恶性肿瘤中，对最小程度腹膜表面播散进行早期积极治疗显示出最大益处。
肿瘤学家必须承担起对癌症腹膜表面播散进行合理管理之责，因为在大型II期研究中已证明了一种治愈性方法，且所有历史对照显示长期生存率为0%。对于发生腹膜表面播散的疾病，应开展围手术期腹腔内化疗的辅助III期研究。
