Garg Pankaj Kumar, Brandl Andreas, Rau Beate
Department of Surgery, University College of Medical Sciences & Guru Teg Bahadur Hospital, University of Delhi, Delhi, India.
Department of General Surgery, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Visc Med. 2018 Dec;34(6):412-416. doi: 10.1159/000493493. Epub 2018 Oct 30.
Peritoneal metastasis (PM) in a gastrointestinal cancer is associated with a poor prognosis. Various guidelines recommend palliative chemotherapy in these patients as cure is not achievable. However, hyperthermic intraperitoneal chemotherapy (HIPEC) in combination with cytoreductive surgery (CRS) can achieve long-term survival with low morbidity in selected patients. During the last decades, CRS and HIPEC have been performed in a number of indications, aiming for long-term survival. What is more, new drugs and treatment regimens demonstrate favorable results.
The recently published important literature on PM in gastrointestinal cancer was analyzed.
Resection of isolated PM in a gastrointestinal cancer should be considered, and HIPEC is feasible. However, there is a lack of well-designed randomized controlled trials (RCTs) in gastrointestinal cancer-related PM. Many RCTs are being conducted across the world whose results will be available in 1-2 years. Systemic chemotherapy alone as an adequate management plan for isolated PM in a gastrointestinal cancer is not compatible with a high standard of care. Formulating an optimal plan combining the benefits of CRS and HIPEC coupled with systemic chemotherapy is a necessary task of the multidisciplinary team. Proper selection of the patients for CRS and HIPEC is necessary to achieve maximal oncological benefit and minimal perioperative morbidity and mortality.
A multidisciplinary approach combining the benefits of both CRS and HIPEC, and systemic chemotherapy is the way forward to manage those patients with gastrointestinal cancer and PM. Further studies are warranted to identify the selection variables for CRS and HIPEC.
胃肠道癌的腹膜转移（PM）与预后不良相关。各种指南建议对这些患者进行姑息化疗，因为无法实现治愈。然而，腹腔热灌注化疗（HIPEC）联合细胞减灭术（CRS）可使部分患者获得长期生存且并发症发生率较低。在过去几十年中，CRS和HIPEC已应用于多种适应症，旨在实现长期生存。此外，新药物和治疗方案显示出良好效果。
分析最近发表的关于胃肠道癌PM的重要文献。
应考虑切除胃肠道癌孤立性PM，且HIPEC是可行的。然而，在胃肠道癌相关PM方面缺乏设计良好的随机对照试验（RCT）。世界各地正在进行许多RCT，其结果将在1 - 2年内公布。单纯全身化疗作为胃肠道癌孤立性PM的充分管理方案不符合高标准治疗要求。制定结合CRS和HIPEC益处以及全身化疗的最佳方案是多学科团队的必要任务。正确选择适合CRS和HIPEC的患者对于实现最大肿瘤学获益以及最小围手术期发病率和死亡率至关重要。
结合CRS和HIPEC以及全身化疗益处的多学科方法是管理胃肠道癌合并PM患者的前进方向。有必要进行进一步研究以确定CRS和HIPEC的选择变量。
