Brigand C, Monneuse O, Mohamed F, Sayag-Beaujard A C, Isaac S, Gilly F N, Glehen O
Department of General Surgery, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.
Ann Surg Oncol. 2006 Mar;13(3):405-12. doi: 10.1245/ASO.2006.05.041. Epub 2006 Jan 30.
Peritoneal mesothelioma is a rare disease with few therapeutic options. Recently, the combination of cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (HIPEC) has shown promising results.
Fifteen patients with peritoneal mesothelioma who were treated by cytoreductive surgery and HIPEC between 1989 and 2004 were identified from a prospective database. HIPEC was performed with cisplatin and mitomycin C for 90 minutes by using the closed-abdomen technique.
All patients but one (multicystic) had malignant disease of the following pathologic types: 12 epithelial and 2 biphasic. After surgical resection, 11 patients were considered to have a CC-0 or CC-1 resection (macroscopic complete resection or diameter of residual nodules <2.5 mm). No postoperative death occurred, and six postoperative complications were recorded. All but one patient had resolution of ascites. The overall median survival for the 14 patients with malignant mesothelioma was 35.6 months. The median survival was 37.8 months for patients treated with a CC-0 or CC-1 resection, whereas it was 6.5 months for those treated with a CC-2 or CC-3 resection (diameter of residual nodules >2.5 mm; P < .001). In a univariate analysis, the only other significant prognostic factor was the carcinomatosis extent (P = .02).
A therapeutic strategy combining cytoreductive surgery with HIPEC seems to provide an adequate and efficient locoregional treatment for peritoneal mesothelioma. It is associated with acceptable morbidity when performed by an experienced surgical team. The completeness of cytoreduction is the major determinant of survival.
腹膜间皮瘤是一种罕见疾病，治疗选择有限。近来，细胞减灭术联合腹腔内热化疗（HIPEC）已显示出有前景的结果。
从一个前瞻性数据库中识别出1989年至2004年间接受细胞减灭术和HIPEC治疗的15例腹膜间皮瘤患者。使用顺铂和丝裂霉素C通过封闭腹腔技术进行90分钟的HIPEC。
除1例（多囊性）外，所有患者均患有以下病理类型的恶性疾病：12例上皮型和2例双向型。手术切除后，11例患者被认为进行了CC-0或CC-1切除（肉眼完全切除或残留结节直径<2.5mm）。未发生术后死亡，记录到6例术后并发症。除1例患者外，所有患者腹水均消退。14例恶性间皮瘤患者的总体中位生存期为35.6个月。接受CC-0或CC-1切除的患者中位生存期为37.8个月，而接受CC-2或CC-3切除（残留结节直径>2.5mm）的患者中位生存期为6.5个月（P<.001）。在单因素分析中，唯一的其他显著预后因素是癌灶范围（P=.02）。
细胞减灭术联合HIPEC的治疗策略似乎为腹膜间皮瘤提供了充分且有效的局部区域治疗。由经验丰富的手术团队进行时，其相关发病率是可接受的。细胞减灭的完整性是生存的主要决定因素。
