Coccolini Federico, Celotti Andrea, Ceresoli Marco, Montori Giulia, Marini Michele, Catena Fausto, Ansaloni Luca
General Surgery Department, Papa Giovanni XXIII Hospital, Bergamo, Italy ;
General and Emergency surgery, Parma Maggiore Hospital, Parma, Italy.
J Gastrointest Oncol. 2016 Aug;7(4):523-9. doi: 10.21037/jgo.2016.06.05.
The possibility to enlarge criteria for intra-peritoneal chemotherapy (IPC) to all patients at high-risk to develop peritoneal carcinosis (i.e., with serosal invasion) is still discussed.
Retrospective case-control study. Three-groups: advanced-gastric-cancer (AGC) (pT4) without proven carcinosis: prophylactic group (PG), those with PC: treatment group (TG), AGC (pT3-pT4) operated without hyperthermic intraperitoneal chemotherapy (HIPEC), surgery alone group (SG T3, SG T4).
Forty four patients. 26 (59.1%) were male. Sixteen (36%) patients underwent 16 HIPEC: 6 (38%) had AGC (pT4) without PC (PG), 10 (62%) had carcinosis (TG), 28 were operated without HIPEC (SG T3, SG T4). The mean disease free survival (DFS): TG: 7.7 months, SG T4: 21.6 months, SG T3: 27.7 months, PG: 34.5 months. DFS was significantly different for TG (P=0.03, P=0.021, P=0.013 respectively). The mean OS TG: 10 months, SG T4: 27.1 months, SG T3: 28.2 months, PG: 34.6 months. OS was significantly different for TG (P=0.04, P=0.04, P=0.045 respectively). Severe complication rate: TG: 60%, PG: 16.7%, SG T3: 7.7% and SG T4: 25% (P=0.035). Length-of-stay differs significantly (P=0.003); overall length-of-stay: 19.41 days [standard deviation (SD) ±15.03]; TG: 33.01 (SD ±23.08), PG: 20.17 (SD ±6.21), SG T3: 11.33 (SD ±3.22), SG T4: 15.36 (SD ±5.48).
Prophylactic intraperitoneal chemotherapy associated to neoadjuvant chemotherapy increases the DFS and OS in patients with AGC without carcinosis. More data are needed in order to confirm these results.
关于将腹腔内化疗（IPC）的标准扩大至所有有发生腹膜癌高风险（即有浆膜侵犯）患者的可能性仍在讨论中。
回顾性病例对照研究。三组：无证实腹膜癌的进展期胃癌（AGC）（pT4）：预防组（PG）；有腹膜癌的患者：治疗组（TG）；未接受热灌注腹腔化疗（HIPEC）仅行手术的AGC（pT3 - pT4）患者，单纯手术组（SG T3、SG T4）。
44例患者。26例（59.1%）为男性。16例（36%）患者接受了16次HIPEC：6例（38%）为无腹膜癌的AGC（pT4）（PG），10例（62%）有腹膜癌（TG），28例未接受HIPEC手术（SG T3、SG T4）。平均无病生存期（DFS）：TG组7.7个月，SG T4组21.6个月，SG T3组27.7个月，PG组34.5个月。TG组的DFS有显著差异（分别为P = 0.03、P = 0.021、P = 0.013）。平均总生存期（OS）：TG组10个月，SG T4组27.1个月，SG T3组28.2个月，PG组34.6个月。TG组的OS有显著差异（分别为P = 0.04、P = 0.04、P = 0.045）。严重并发症发生率：TG组60%，PG组16.7%，SG T3组7.7%，SG T4组25%（P = 0.035）。住院时间有显著差异（P = 0.003）；总体住院时间：19.41天[标准差（SD）±15.03]；TG组33.01（SD ±23.08），PG组20.17（SD ±6.21），SG T3组11.33（SD ±3.22），SG T4组15.36（SD ±5.48）。
新辅助化疗联合预防性腹腔内化疗可提高无腹膜癌的AGC患者的DFS和OS。需要更多数据来证实这些结果。
