Sugarbaker P H, Cunliffe W J, Belliveau J, de Bruijn E A, Graves T, Mullins R E, Schlag P
Cancer Institute, Washington Hospital Center, Washington, DC 20010.
Semin Oncol. 1989 Aug;16(4 Suppl 6):83-97.
A new concept in the natural history of gastrointestinal (GI) cancer suggests that recurrence of this malignancy can be separated into two types. Hematogenous and lymphatic metastases occur before surgical removal of the primary cancer. The spread of cancer to the resection site and to peritoneal surfaces occurs at the time of surgical removal of the primary tumor. Surgical trauma leads to a dispersal of malignant tumor emboli, which then implant within the raw tissue surfaces of the resection site and abraded peritoneal surfaces. Instillation of chemotherapy directly into the peritoneal cavity, as part of GI surgery, provides cytotoxic levels of drug that may change the natural history of GI cancer. The most common sites of disease recurrence have been, in the past, at the resection site and on peritoneal surfaces. With the optimal use of intraperitoneal chemotherapy, these sites of surgical treatment failure should no longer occur. Early phase I and II and pharmacologic studies suggest that an effective dose and schedule have been achieved, that toxicity is at reasonable levels, and that responses with small volumes of intra-abdominal cancer are exceptionally high. Chemotherapy that has an impact on the surgical event by decreasing cancer spread to the resection site and to peritoneal surfaces may significantly improve survival and quality of life in patients with GI cancer.
胃肠道（GI）癌自然史的一个新概念表明，这种恶性肿瘤的复发可分为两种类型。血行转移和淋巴转移发生在原发性癌症手术切除之前。癌症扩散至切除部位和腹膜表面发生在原发性肿瘤手术切除之时。手术创伤导致恶性肿瘤栓子扩散，然后植入切除部位的新鲜组织表面和受损的腹膜表面。作为胃肠道手术的一部分，将化疗药物直接注入腹腔可提供细胞毒性水平的药物，这可能改变胃肠道癌的自然史。过去，疾病复发最常见的部位是切除部位和腹膜表面。通过优化使用腹腔内化疗，这些手术治疗失败的部位不应再出现。早期的I期和II期及药理学研究表明，已达到有效剂量和给药方案，毒性处于合理水平，对少量腹腔内癌症的反应异常高。通过减少癌症扩散至切除部位和腹膜表面而对手术事件产生影响的化疗可能会显著提高胃肠道癌患者的生存率和生活质量。
