Department of Surgery, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey.
Department of Medical Oncology, Dokuz Eylul University School of Medicine, Balcova, 35340, Izmir, Turkey.
World J Surg Oncol. 2018 Mar 27;16(1):70. doi: 10.1186/s12957-018-1369-7.
Diagnosis of peritoneal carcinomatosis (PC) may be missed by preoperative imaging. We are presenting our experience with incidentally detected PC of colorectal origin treated with cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) at the same operation.
Between January 2010 and September 2016, 19 patients underwent CRS and IPC due to incidentally detected PC of colorectal origin. Data were analyzed from a prospectively collected database.
The median age was 59 (29-78). In three patients, PC was diagnosed during emergency surgery. The primary tumor was located in the rectum (three patients; one with recurrent disease), left colon (9 patients), and right colon (7 patients). All patients underwent CRS and IPC, and one patient operated laparoscopically. Median peritoneal cancer index (PCI) was 5 (range, 3-14), and complete cytoreduction (CC-0) was achieved in 14 patients. After CRS, 8 patients received early postoperative intraperitoneal chemotherapy (EPIC), 7 patients received hyperthermic intraperitoneal chemotherapy (HIPEC), and 4 patients received both HIPEC and EPIC. The median hospital stay was 9 (6-29) days. Postoperative complications occurred in 6 patients. There was no postoperative mortality. Median follow-up was 40.2 (12-94) months. Five-year overall survival was 63.2%. Estimated mean survival time is longer in patients who underwent complete cytoreduction compared to patients having CC-1 or CC-2 cytoreduction (87.7 vs. 20.3 months; p < 0.001).
Cytoreductive surgery and IPC can be performed safely in patients with intraoperatively detected incidental PC of colorectal origin.
术前影像学检查可能会漏诊腹膜癌（PC）。我们报告了在同一手术中对偶然发现的结直肠来源 PC 采用细胞减灭术（CRS）和腹腔内化疗（IPC）进行治疗的经验。
2010 年 1 月至 2016 年 9 月期间，19 例患者因偶然发现的结直肠来源 PC 接受了 CRS 和 IPC。数据来自一个前瞻性收集的数据库进行分析。
中位年龄为 59 岁（29-78 岁）。有 3 例患者在急诊手术中诊断为 PC。原发肿瘤位于直肠（3 例，其中 1 例为复发性疾病）、左半结肠（9 例）和右半结肠（7 例）。所有患者均接受了 CRS 和 IPC，其中 1 例患者接受了腹腔镜手术。中位腹膜癌指数（PCI）为 5（范围 3-14），14 例患者达到完全肿瘤减灭（CC-0）。CRS 后，8 例患者接受了早期术后腹腔内化疗（EPIC），7 例患者接受了腹腔内热化疗（HIPEC），4 例患者同时接受了 HIPEC 和 EPIC。中位住院时间为 9 天（6-29 天）。术后并发症发生在 6 例患者中。无术后死亡。中位随访时间为 40.2 个月（12-94 个月）。5 年总生存率为 63.2%。与接受 CC-1 或 CC-2 肿瘤减灭术的患者相比，行完全肿瘤减灭术的患者的估计平均生存时间更长（87.7 与 20.3 个月；p<0.001）。
对于术中偶然发现的结直肠来源的 PC 患者，可安全地进行 CRS 和 IPC。
