Dohan A, Barral M, Eveno C, Lo Dico R, Kaci R, Pasteur-Rousseau A, Soyer P, Pocard M, Bonnin P
CART, INSERM UMR965, Sorbonne Paris Cité, Université Paris Diderot, Hôpital Lariboisière, Paris, France; AP-HP, Hôpital Lariboisière, Radiologie Viscérale et Vasculaire, F-75010, Paris, France.
CART, INSERM UMR965, Sorbonne Paris Cité, Université Paris Diderot, Hôpital Lariboisière, Paris, France; AP-HP, Hôpital Lariboisière, Chirurgie Digestive et Oncologique, F-75010, Paris, France.
Eur J Surg Oncol. 2017 Oct;43(10):1932-1938. doi: 10.1016/j.ejso.2017.05.015. Epub 2017 May 25.
Pseudomyxoma peritonei (PMP) is a rare carcinomatosis limited to the peritoneal cavity, mainly supplied by the superior mesenteric artery (SMA). The only curative treatment is cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal chemotherapy. This study aimed to evaluate the ability of blood flow volume (BFV) recorded in the SMA using Doppler ultrasonography pre-operatively to predict the extent and resectability of the disease and post-operatively to assess clinical outcome.
BFV was measured in the SMA of forty-nine patients before and the year following CRS. Patients were categorized in 3 groups according to clinical and surgical outcomes: group-1 (n = 22): patient with completed CRS, group-2 (n = 16): incomplete resection with slowly progressive disease (alive at 2 years without severe clinical symptoms), group-3 (n = 11): incomplete resection and with severe clinical symptoms or dead within two years.
Pre-operative mean SMA BFV was higher in group-2 (510 mL/min, p = 0.027) and in group-3 (572 mL/min, p = 0.004) than in group-1 (378 mL/min). After surgery, BFV dropped to normal values (203 mL/min, p = 0.001) in group-1, and to 423 mL/min (p = 0.047) in group-2. It remained elevated in group-3 (626 mL/min, p = 0.566). BFV allowed stratification of 1) resectability before CRS (group-2 and -3 vs group-1, area under the ROC curve: 0.794 [0.650-0.939]), and 2) non progression after incomplete CRS (group-3 vs group-2, area under the ROC curve: 0.827 [0.565-1.00].
Pre-operative BFV in the SMA correlates with extent and resectability of PMP. After incomplete surgery, post-operative BFV might aid in identifying patients who may benefit of post-operative therapy.
腹膜假黏液瘤（PMP）是一种局限于腹腔的罕见癌病，主要由肠系膜上动脉（SMA）供血。唯一的根治性治疗方法是细胞减灭术（CRS）联合腹腔内热灌注化疗。本研究旨在评估术前使用多普勒超声测量SMA血流容积（BFV）预测疾病范围和可切除性以及术后评估临床结局的能力。
在49例患者CRS术前及术后1年测量其SMA的BFV。根据临床和手术结局将患者分为3组：1组（n = 22）：CRS完成的患者；2组（n = 16）：切除不完全且疾病缓慢进展（2年存活且无严重临床症状）；3组（n = 11）：切除不完全且有严重临床症状或2年内死亡。
2组（510 mL/min，p = 0.027）和3组（572 mL/min，p = 0.004）术前SMA平均BFV高于1组（378 mL/min）。术后，1组BFV降至正常水平（203 mL/min，p = 0.001），2组降至423 mL/min（p = 0.047）。3组仍升高（626 mL/min，p = 0.566）。BFV可用于分层：1）CRS术前的可切除性（2组和3组对比1组，ROC曲线下面积：0.794 [0.650 - 0.939]），以及2）不完全CRS术后的无进展情况（3组对比2组，ROC曲线下面积：0.827 [0.565 - 1.00]）。
术前SMA的BFV与PMP的范围和可切除性相关。不完全手术后，术后BFV可能有助于识别可能从术后治疗中获益的患者。
