Klaver C E L, Groenen H, Morton D G, Laurberg S, Bemelman W A, Tanis P J
Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
Academic Department of Surgery, University of Birmingham, Edgbaston, Birmingham, UK.
Colorectal Dis. 2017 Mar;19(3):224-236. doi: 10.1111/codi.13593.
This systematic review aimed to provide an overview of (inter)national guidelines on the treatment of peritoneal metastases of colorectal cancer origin (PMCRC) and to determine the degree of consensus and available evidence with identification of topics for future research.
A systematic search of MEDLINE, Embase, PubMed as well as Tripdatabase, National Guideline Clearinghouse, BMJ Best Practice and Guidelines International Network was performed to identify (inter)national guidelines and consensus statements from oncological or surgical societies on PMCRC. The quality of guidelines was assessed using the AGREE-II score. Topics followed by recommendations were extracted from the guidelines. The recommendations, highest level of supporting evidence and the degree of consensus were determined for each topic.
Twenty-one guidelines were included, in most (15) of which cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) was recommended in selected patients based on level 1b evidence. Substantial consensus was also reached on the benefit of multidisciplinary team discussion and the achievability of a (near) complete cytoreduction (CC0-1) without supporting evidence. Both evidence and consensus were lacking regarding other aspects including preoperative positron emission tomography/CT, second look surgery in high risk patients, the optimal patient selection for CRS/HIPEC, procedural aspects of HIPEC and (perioperative) systemic therapy.
In currently available guidelines, evidence and consensus on the treatment strategy for PMCRC are lacking. Updates of guidelines are ongoing and future (randomized) clinical trials should contribute to multidisciplinary and international consensus on treatment strategies for PMCRC.
本系统评价旨在概述关于结直肠癌源性腹膜转移（PMCRC）治疗的（国际）指南，并确定共识程度和现有证据，同时确定未来研究的主题。
对MEDLINE、Embase、PubMed以及Tripdatabase、国家指南交换中心、BMJ最佳实践和指南国际网络进行系统检索，以确定肿瘤学或外科学会关于PMCRC的（国际）指南和共识声明。使用AGREE-II评分评估指南质量。从指南中提取有推荐意见的主题。确定每个主题的推荐意见、最高级别的支持证据和共识程度。
纳入了21项指南，其中大多数（15项）基于1b级证据推荐在特定患者中进行细胞减灭术联合腹腔热灌注化疗（CRS/HIPEC）。对于多学科团队讨论的益处以及（近乎）完全细胞减灭（CC0-1）的可实现性也达成了实质性共识，但缺乏支持证据。在其他方面，包括术前正电子发射断层扫描/计算机断层扫描、高危患者的二次探查手术、CRS/HIPEC的最佳患者选择、HIPEC的操作方面以及（围手术期）全身治疗，证据和共识均不足。
在目前可用的指南中，缺乏关于PMCRC治疗策略的证据和共识。指南更新正在进行中，未来的（随机）临床试验应有助于就PMCRC的治疗策略达成多学科和国际共识。
