Brandl Andreas, Zielinski Christina Barbara, Raue Wieland, Pratschke Johann, Rau Beate
Department of General, Visceral and Transplantation Surgery and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Virchow and Mitte, Charité, Universitätsmedizin Berlin, Berlin, Germany.
Ann Med Surg (Lond). 2017 Aug 9;22:7-11. doi: 10.1016/j.amsu.2017.08.009. eCollection 2017 Oct.
In selected cases, cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for patients suffering from peritoneal metastases from colorectal, ovarian, gastric or appendiceal origin. The effectiveness of this extensive has not been elucidated within other rare diseases by now.
We conducted a retrospective analysis of patients treated with CRS for peritoneal carcinomatosis during the period between July 2010 and September 2015. Exclusion criteria were adenocarcinomas of the stomach, colon, neoplasms of the appendix, mesothelioma and ovarian cancers. Aim of this study was to examine the feasibility, complication rate and survival of patients with rare diseases.
A total of 14 Patients were included: Four rare gynecological tumors, three adenocarcinomas of the small intestine, three retroperitoneal sarcomas, one cholangiocellular carcinoma, one neuroendocrine gastric tumor, one malignant peripheral nerve sheath tumor and one cancer of unknown primary syndrome. In 12 of 14 patients a macroscopically complete tumorresection could be achieved. No patient died during hospitalization. Seven of 14 patients experienced general complication of grade III according to NCI CTCAE V4.0, while two experienced complications of grade IV. Median follow-up and one year overall survival were 15.5 months and 46.8%, respectively.
For patients with rare tumors, CRS and HIPEC is feasible with an acceptable perioperative morbidity and mortality. To improve knowledge in patient selection and outcome, rare tumors treated with CRS and HIPEC should be documented in central databases (as for example BIG RENAPE, Pierre-Benite, France).
在特定病例中,细胞减灭术(CRS)和腹腔内热灌注化疗(HIPEC)是治疗结直肠癌、卵巢癌、胃癌或阑尾癌所致腹膜转移患者的既定疗法。目前,该疗法在其他罕见疾病中的有效性尚未阐明。
我们对2010年7月至2015年9月期间接受CRS治疗腹膜癌的患者进行了回顾性分析。排除标准为胃癌、结肠癌腺癌、阑尾肿瘤、间皮瘤和卵巢癌。本研究的目的是检验罕见疾病患者的可行性、并发症发生率和生存率。
共纳入14例患者:4例罕见妇科肿瘤、3例小肠腺癌、3例腹膜后肉瘤、1例胆管细胞癌、1例神经内分泌胃肿瘤、1例恶性外周神经鞘瘤和1例原发综合征不明的癌症。14例患者中有12例实现了肉眼可见的肿瘤完全切除。住院期间无患者死亡。根据美国国立癌症研究所(NCI)CTCAE V4.0标准,14例患者中有7例发生Ⅲ级全身并发症,2例发生Ⅳ级并发症。中位随访时间和1年总生存率分别为15.5个月和46.8%。
对于罕见肿瘤患者,CRS和HIPEC是可行的,围手术期发病率和死亡率可接受。为提高患者选择和预后方面的认知,接受CRS和HIPEC治疗的罕见肿瘤应记录在中央数据库中(如法国皮埃尔 - 贝尼特的BIG RENAPE)。