1. Theodor-Billroth-Academy®, Munich, Germany ; 7. Bon Secours Cancer Institute, Richmond, VA, USA ; 8. INCORE = International Consortium of Research Excellence of the Theodor-Billroth-Academy®
J Cancer. 2013;4(3):262-9. doi: 10.7150/jca.5831. Epub 2013 Mar 15.
Peritoneal surface malignancy (PSM) is a frequent occurrence in the natural history of colorectal cancer (CRC). Although significant advances have been made in screening of CRC, similar progress has yet to be made in the early detection of PSM of colorectal cancer origin. The fact that advanced CRC can be confined to the peritoneal surface without distant dissemination forms the basis for aggressive multi-modality therapy consisting of cytoreductive surgery (CRS) plus hyperthermic intra-peritoneal chemotherapy (HIPEC), and neoadjuvant and/or adjuvant systemic therapy. Reported overall survival with complete CRS+HIPEC exceeds that of systemic therapy alone for the treatment of PSM from CRC, underscoring the advantage of this multi-modality therapeutic approach. Patients with limited peritoneal disease from CRC can undergo complete cytoreduction, which is associated with the best reported outcomes. As early or limited peritoneal carcinomatosis is undetectable by conventional imaging modalities, second look laparotomy is an important means to identify disease in high-risk patients at a stage most amenable to complete cytoreduction. This review focuses on the identification of patients at risk for PSM from CRC and discusses the role of second look laparotomy.
腹膜表面恶性肿瘤（PSM）是结直肠癌（CRC）自然病程中的常见现象。尽管在 CRC 的筛查方面取得了重大进展，但在结直肠来源的 PSM 的早期检测方面尚未取得类似的进展。晚期 CRC 可以局限于腹膜表面而无远处播散的事实为包括细胞减灭术（CRS）加腹腔内热化疗（HIPEC）在内的积极多模式治疗以及新辅助和/或辅助全身治疗奠定了基础。报道的完全 CRS+HIPEC 总生存率超过了单独全身治疗 CRC 的 PSM，突出了这种多模式治疗方法的优势。来自 CRC 的有限腹膜疾病患者可以进行完全减瘤，这与报道的最佳结果相关。由于传统影像学检查方法无法检测到早期或有限的腹膜癌转移，因此二次探查手术是识别高危患者中最适合完全减瘤的疾病的重要手段。这篇综述重点介绍了识别有 PSM 风险的 CRC 患者，并讨论了二次探查手术的作用。
