Brandl A, Pachmayr E, Gül-Klein S, Alberto M, Thuss-Patience P, Rau B
Chirurgische Klinik, Campus Virchow-Klinikum und Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
Chirurg. 2018 Sep;89(9):669-677. doi: 10.1007/s00104-018-0625-2.
Up to 17% of all patients with gastric cancer are diagnosed with the presence of peritoneal metastases, which is associated with a poor prognosis. The most promising results were shown with multimodal treatment regimens including systemic chemotherapy and cytoreductive surgery (CRS). A subsequent hyperthermic intraperitoneal chemotherapy (HIPEC).possibly has a positive effect and is currently being tested.
This manuscript highlights the key role of CRS and HIPEC in patients with peritoneal metastases of gastric cancer and illustrates which patients benefit from this intensive therapy.
We performed a comprehensive review of the literature to demonstrate relevant aspects in the treatment of peritoneal metastases in gastric cancer.
The use of CRS and HIPEC improves the overall survival to 11 months compared to best supportive care in selected patients. Patients who present with low volume peritoneal disease (peritoneal cancer index ≤6) have the best prognosis. This intensive treatment is associated with a relatively high morbidity (15-50%) and mortality (1-10%). Complete cytoreduction, i.e. a complete macroscopic absence of tumor tissue after resection is the most important prognostic factor.
The CRS and HIPEC procedures have a proven survival benefit in selected patients. Due to the relatively high morbidity and mortality, the evaluation should be performed by an experienced team including a surgical oncologist, medical oncologist and intensive care physician, to achieve the highest rate of complete cytoreduction in combination with low morbidity; however, the effect of HIPEC has to be proven and the results of the randomized GASTRIPEC trial are awaited.
高达17%的胃癌患者被诊断存在腹膜转移，这与预后不良相关。包括全身化疗和细胞减灭术（CRS）的多模式治疗方案显示出最有前景的结果。随后的腹腔内热灌注化疗（HIPEC）可能具有积极作用，目前正在进行试验。
本手稿强调了CRS和HIPEC在胃癌腹膜转移患者中的关键作用，并阐明了哪些患者能从这种强化治疗中获益。
我们对文献进行了全面综述，以展示胃癌腹膜转移治疗中的相关方面。
与选定患者的最佳支持治疗相比，使用CRS和HIPEC可将总生存期提高至11个月。腹膜疾病范围小（腹膜癌指数≤6）的患者预后最佳。这种强化治疗的发病率（15 - 50%）和死亡率（1 - 10%）相对较高。完全细胞减灭，即切除后肿瘤组织在宏观上完全消失，是最重要的预后因素。
CRS和HIPEC手术在选定患者中已证明具有生存获益。由于发病率和死亡率相对较高，应由包括外科肿瘤学家、医学肿瘤学家和重症监护医师在内的经验丰富的团队进行评估，以实现最高的完全细胞减灭率并降低发病率；然而，HIPEC的效果有待证实，目前正在等待随机GASTRIPEC试验的结果。
