Yonemura Y, Kawamura T, Bandou E, Takahashi S, Sawa T, Matsuki N
Peritoneal Dissemination Programme, Shizuoka Cancer Centre, 1007 Shimo-nagakubo, Nagaizumi-machi, Suntougun, Shizuoka 411-8777, Japan.
Br J Surg. 2005 Mar;92(3):370-5. doi: 10.1002/bjs.4695.
There is no standard treatment for peritoneal dissemination from gastric cancer. A novel treatment consisting of peritonectomy and intraoperative chemohyperthermic peritoneal perfusion (CHPP) was compared with conventional surgery and CHPP.
Records of all patients who underwent CHPP after cytoreductive surgery between 1992 and 2002 were reviewed.
Data for 107 patients with peritoneal dissemination were available. Complete cytoreduction was achieved in 47 (43.9 per cent) of the 107 patients: 18 of 65 who underwent conventional surgery and 29 of 42 who had peritonectomy. Twenty-three patients (21.5 per cent) suffered from complications. The overall operative mortality rate was 2.8 per cent. Seventeen patients (15.9 per cent) were disease free and 87 subsequent deaths were related to disease progression. The median survival for all patients was 11.5 months, with a 5-year survival rate of 6.7 per cent. Median survival after complete cytoreduction was 15.5 months and that after incomplete cytoreduction was 7.9 months, with 5-year survival rates of 13 and 2 per cent respectively. Completeness of cytoreduction and peritonectomy were independent prognostic factors. The 5-year survival rate after complete cytoreduction by peritonectomy with CHPP was 27 per cent.
Complete cytoreduction after peritonectomy and CHPP may improve the survival of patients with peritoneal dissemination from gastric cancer.
对于胃癌腹膜播散尚无标准治疗方法。将一种由腹膜切除术和术中温热化疗性腹腔灌注（CHPP）组成的新型治疗方法与传统手术及CHPP进行比较。
回顾了1992年至2002年间所有接受减瘤手术后进行CHPP的患者记录。
获得了107例腹膜播散患者的数据。107例患者中有47例（43.9%）实现了完全减瘤：65例行传统手术的患者中有18例，42例行腹膜切除术的患者中有29例。23例患者（21.5%）出现并发症。总体手术死亡率为2.8%。17例患者（15.9%）无疾病，随后87例死亡与疾病进展相关。所有患者的中位生存期为11.5个月，5年生存率为6.7%。完全减瘤后的中位生存期为15.5个月，不完全减瘤后的中位生存期为7.9个月，5年生存率分别为13%和2%。减瘤的完整性和腹膜切除术是独立的预后因素。通过腹膜切除术联合CHPP实现完全减瘤后的5年生存率为27%。
腹膜切除术和CHPP后实现完全减瘤可能提高胃癌腹膜播散患者的生存率。
