Abu-Zaid Ahmed, Azzam Ayman Zaki, AlOmar Osama, Salem Hany, Amin Tarek, Al-Badawi Ismail A
Dr. Ismail A. Al-Badawi, MBC 52 Department of Obstetrics and Gynecology,, PO Box 3354, King Faisal Specialist Hospital and Research Centre,, Riyadh 11211, Saudi Arabia, T: +966-11- 442-7392, F: +966-11-442-7393,
Ann Saudi Med. 2014 Mar-Apr;34(2):159-66. doi: 10.5144/0256-4947.2014.159.
Endometrial carcinoma is the most common gynecologic malignancy worldwide. Prognosis of patients with peritoneal carcinomatosis (PC) from endometrial carcinoma is deadly, with an estimated median survival not exceeding 12 months. The objective of this study was to report our experience with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for managing PC from primary and recurrent endometrial carcinoma.
A retrospective analysis of 6 patients with PC arising from endometrial cancer, who were managed with CRS and HIPEC at our referral tertiary care center, from November 2010 to August 2013.
Six patients underwent CRS and HIPEC. CRS was performed using standard peritonectomy procedures and visceral resections directed toward the complete elimination of tumors from ab.dominopelvic cavity. HIPEC was performed with cisplatin (50 mg/m2) and doxorubicin (15 mg/m2) and allowed to circulate in abdominopelvic cavity for 90 minutes at 41.0 to 42.2°C.
Two patients with primary endometrial carcinoma and 4 patients with recurrent endometrial carcino.ma confined to peritoneal cavity were studied. Complete cytoreduction (CC-0) was achieved in 5 patients. The International Federation of Gynecology and Obstetrics (FIGO) stages and histopathological types were as follows: IB endometrioid adenocarcinomas (n=1), IC mesonephric carcinomas (n=1), IIIA endometrioid adenocarcino.mas (n=2), IIIA papillary serous carcinomas (n=1), and IIIC clear-cell carcinomas (n=1). Anastomotic leak (grade I) was the most commonly encountered postoperative complication. Two patients developed grade IV compli.cations due to septicemia and pulmonary embolism. No intraoperative mortality occurred. Postoperatively, all patients received chemotherapy (carboplatin and paclitaxel). In 1 patient, the clear-cell carcinoma histologic lesion relapsed within 6 months; the metastases spread to hepatic, pelvic, and mesenteric lymph nodes, and the patient died 5 months later. One patient with cytoreduction completeness of CC-2 developed hepatic metastases within 3 months and is still alive at a follow-up up 6 months. Remaining patients (n=4) are alive and disease free without evidence of recurrence of follow-ups at 35, 34, 19, and 7 months.
CRS and HIPEC are well-tolerated and feasibly promising management modalities in PC from primary and recurrent endometrial carcinoma. Further research is needed for in-depth analysis.
子宫内膜癌是全球最常见的妇科恶性肿瘤。子宫内膜癌伴腹膜转移（PC）患者的预后极差，估计中位生存期不超过12个月。本研究的目的是报告我们采用细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）治疗原发性和复发性子宫内膜癌所致PC的经验。
对2010年11月至2013年8月在我们的三级转诊中心接受CRS和HIPEC治疗的6例子宫内膜癌所致PC患者进行回顾性分析。
6例患者接受了CRS和HIPEC。CRS采用标准的腹膜切除术和脏器切除术，旨在从腹腔盆腔完全清除肿瘤。HIPEC使用顺铂（50mg/m²）和阿霉素（15mg/m²），在41.0至42.2°C下在腹腔盆腔内循环90分钟。
研究了2例原发性子宫内膜癌患者和4例局限于腹腔的复发性子宫内膜癌患者。5例患者实现了完全细胞减灭（CC-0）。国际妇产科联合会（FIGO）分期和组织病理学类型如下：IB期子宫内膜样腺癌（n=1）、IC期中肾癌（n=1）、IIIA期子宫内膜样腺癌（n=2）、IIIA期乳头状浆液性癌（n=1）和IIIC期透明细胞癌（n=1）。吻合口漏（I级）是最常见的术后并发症。2例患者因败血症和肺栓塞出现IV级并发症。无术中死亡发生。术后，所有患者均接受化疗（卡铂和紫杉醇）。1例透明细胞癌组织学病变在6个月内复发；转移扩散至肝、盆腔和肠系膜淋巴结，患者5个月后死亡。1例细胞减灭完全性为CC-2的患者在3个月内发生肝转移，随访6个月时仍存活。其余患者（n=4）存活且无疾病，在35、34、19和7个月的随访中无复发迹象。
CRS和HIPEC在原发性和复发性子宫内膜癌所致PC中耐受性良好且有望成为可行的治疗方式。需要进一步研究进行深入分析。
