Ceelen Wim P
Department of Surgery, Ghent University Hospital, Ghent, Belgium.
Surg Technol Int. 2005;14:125-30.
Approximately 1 in 30 patients suffering from colorectal cancer (CRC) will develop peritoneal carcinomatosis (PC) in the absence of systemic spread. The mechanisms giving rise to PC in CRC are incompletely understood, but involve a complex stepwise interaction between the malignant cell and mesothelial layer. Systemic palliative chemotherapy is usually offered, but of limited activity in PC. Cytoreductive surgery followed by intraperitoneal hyperthermic chemoperfusion (HIPEC) has been described recently in management of isolated PC originating from CRC, based on a sound biological rationale of synergism and a pharmacokinetical advantage. Several retrospective series, one prospective randomized trial, and a meta analysis have clearly shown a survival benefit for patients treated with cytoreduction + HIPEC provided a complete (R0) resection is performed. Toxicity of the procedure is considerable, and mainly depends on the extent of surgery. Future trials are needed to provide more solid evidence in favor of surgery in PC originating from CRC in the era of modern chemotherapy and to better define the role of HIPEC as an adjunct to surgery.
在没有全身扩散的情况下，约每30例结直肠癌（CRC）患者中就有1例会发生腹膜癌转移（PC）。CRC发生PC的机制尚未完全明确，但涉及恶性细胞与间皮细胞层之间复杂的逐步相互作用。通常会进行全身姑息化疗，但对PC的疗效有限。基于协同作用的合理生物学原理和药代动力学优势，最近有人描述了在源自CRC的孤立性PC的治疗中采用细胞减灭术联合腹腔内热灌注化疗（HIPEC）。多个回顾性系列研究、一项前瞻性随机试验以及一项荟萃分析均清楚表明，若能实现完整（R0）切除，接受细胞减灭术+HIPEC治疗的患者可获得生存获益。该手术的毒性相当大，且主要取决于手术范围。未来需要开展更多试验，以便在现代化疗时代为源自CRC的PC患者接受手术治疗提供更确凿的证据，并更好地明确HIPEC作为手术辅助手段的作用。
