对于腹膜癌转移，胆囊切除术和肝圆韧带切除术是细胞减灭术和腹腔热灌注化疗（HIPEC）中的必要步骤吗？
Is cholecystectomy and removal of the round ligament of the liver a necessary step in cytoreductive surgery and HIPEC, for peritoneal carcinomatosis?
作者信息
Halkia Evgenia, Kopanakis Nikos, Valavanis Christos, Nikolaou George, Zouridis Andreas, Vafias Evangelos, Datsis Anastasios, Spiliotis John
出版信息
Ann Ital Chir. 2015 Jul-Aug;86(4):323-6.
AIM
To determine if cholecystectomy and liver's round ligament removal is a necessary step during cytoreductive surgery (CRS) and HIPEC METHODS: This was a retrospective observational study based on records from 180 patients treated in our center from 2005 to 2014. All patients have been offered CRS and HIPEC for peritoneal pseudomixoma (20 patients), peritoneal mesothelioma (7 patients), peritoneal carcinomatosis from ovarian cancer (66 patients), colorectal cancer (42 patients), gastric cancer (10 patients), mucinous adenocarcinoma of the appendix (28), and other abdominal malignancies (7 patients). We performed a cholecystectomy and we removed the round ligament of the liver in all patients, even if there wasn't a macroscopic tumor infiltration of the above anatomical structures. We reviewed the histological reports of all 180 patients.
RESULTS
Patients with peritoneal carcinomatosis from mucinous adenocarcinoma of the appendix were treated more aggressively, due to the macroscopic appearance of the disease. Histologic report show no evidence of metastases at the round ligament of the liver in 21, 4% of the patients that were treated with CRS although it was estimated to be involved based on the macroscopic examination at the time of surgery. Tumor involvement of the gallbladder was overestimated, macroscopically, at the same patients in 25% of the cases. In patients with peritoneal carcinomatosis from ovarian cancer, macroscopic appearance of the gallbladder may be delusive. In 25% of the above patients there was a microscopic tumor involvement of the gallbladder, although there was not macroscopic evidence of the disease.
CONCLUSION
More extended cytoreductive surgery is needed in case of peritoneal carcinimatosis from ovarian cancer. In case of PC from mucinous adenocarcinoma of the appendix, it's difficult to calculate the extent of the disease and avoid unnecessary surgical excisions. More data is needed to confirm the above.
KEY WORDS
Cytoreductive surgery, Gallbladder, HIPEC, Peritoneal carcinomatosis, Round ligament of the liver.
目的
确定胆囊切除术和肝圆韧带切除术是否为细胞减灭术（CRS）及热灌注化疗（HIPEC）过程中的必要步骤。
方法
这是一项回顾性观察研究，基于2005年至2014年在我们中心接受治疗的180例患者的记录。所有患者均因腹膜假黏液瘤（20例）、腹膜间皮瘤（7例）、卵巢癌腹膜转移癌（66例）、结直肠癌（42例）、胃癌（10例）、阑尾黏液腺癌（28例）及其他腹部恶性肿瘤（7例）接受了CRS和HIPEC。我们对所有患者均实施了胆囊切除术并切除了肝圆韧带，即便上述解剖结构无肉眼可见的肿瘤浸润。我们查阅了所有180例患者的组织学报告。
结果
阑尾黏液腺癌腹膜转移癌患者因疾病的肉眼表现接受了更积极的治疗。组织学报告显示，在接受CRS治疗的患者中，21.4%的患者肝圆韧带无转移证据，尽管根据手术时的肉眼检查估计该部位受累。在同一组患者中，25%的病例胆囊的肿瘤累及情况在肉眼检查时被高估。在卵巢癌腹膜转移癌患者中，胆囊的肉眼表现可能具有误导性。在上述患者中，25%存在胆囊微小肿瘤累及，尽管无疾病的肉眼证据。
结论
卵巢癌腹膜转移癌患者需要更广泛的细胞减灭术。对于阑尾黏液腺癌所致的腹膜假黏液瘤，难以计算疾病范围并避免不必要的手术切除。需要更多数据来证实上述情况。
关键词
细胞减灭术；胆囊；热灌注化疗；腹膜转移癌；肝圆韧带
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