Peritoneal Surface Malignancy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori Milano, via Venezian 1, Milan, MI, CAP 20133, Italy.
Department of Surgical Oncology, Jehangir Hospital, Sassoon Road, Pune, 411001, Maharashtra, India.
Eur J Surg Oncol. 2019 Nov;45(11):2103-2108. doi: 10.1016/j.ejso.2019.06.021. Epub 2019 Jun 13.
INTRODUCTION: Serous papillary peritoneal carcinoma (SPPC) is a rare clinical entity. Based on the understanding of the pattern of spread, its multifocality, polyclonality and the high frequency of diffuse, widespread peritoneal metastasis, a robust rationale for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for SPPC exists. Herein we report the clinical outcomes of SPPC patients treated with neoadjuvant systemic chemotherapy (NACT) followed by CRS including total parietal peritonectomy and HIPEC. METHODS: Clinico-pathological data of 22 patients of serous papillary peritoneal carcinoma (SPPC) was retrospectively analyzed from a prospectively maintained database from June 2000 to July 2017. Patients were treated with CRS, total parietal peritonectomy and HIPEC with cisplatin (42 mg/L of perfusate) and doxorubicin (15 mg/L of perfusate) after NACT. Survival curves were calculated from the date of surgery. RESULTS: 22 patients underwent CRS, total parietal peritonectomy and HIPEC. The median age was 62 years (Range 47-72). On histological evaluation, 18/30 (60%) parietal peritonectomy specimens showed microscopic disease, when no disease was evident macroscopically at surgical exploration. Grade III-IV surgical complications were recorded in 4/22 (18%) patients. There was no postoperative mortality. At a median follow up of 12 months, the five-year overall survival (OS) was 64.9%. The median OS was not reached. Median progression-free survival was 32.9 months and progression-free survival at 5 years was 33.2%. CONCLUSION: CRS with total peritonectomy + HIPEC after NACT, presents as a promising treatment modality for SPPC, and could be associated with good survival results in patients with SPPC.
简介:浆液性乳头状腹膜癌(SPPC)是一种罕见的临床实体。基于对其播散模式、多灶性、多克隆性以及弥漫性、广泛腹膜转移高发性的认识,对于 SPPC 患者,细胞减灭术(CRS)联合腹腔热灌注化疗(HIPEC)具有强有力的理论依据。在此,我们报告了接受新辅助全身化疗(NACT)后行 CRS 联合全腹膜切除术和 HIPEC 治疗的 SPPC 患者的临床结果。
方法:回顾性分析了 2000 年 6 月至 2017 年 7 月期间前瞻性维护的数据库中 22 例浆液性乳头状腹膜癌(SPPC)患者的临床病理资料。患者在 NACT 后接受 CRS、全腹膜切除术和 HIPEC,顺铂(灌注液 42mg/L)和多柔比星(灌注液 15mg/L)。从手术日期开始计算生存曲线。
结果:22 例患者接受了 CRS、全腹膜切除术和 HIPEC。中位年龄为 62 岁(范围 47-72)。在组织学评估中,18/30(60%)腹膜切除术标本显示显微镜下疾病,而在手术探查时宏观上无疾病。22 例患者中有 4 例(18%)记录到 3/4 级手术并发症。无术后死亡。中位随访 12 个月时,5 年总生存率(OS)为 64.9%。中位 OS 未达到。中位无进展生存期为 32.9 个月,5 年无进展生存率为 33.2%。
结论:NACT 后行 CRS 联合全腹膜切除术+HIPEC 是治疗 SPPC 的一种很有前途的治疗方法,可为 SPPC 患者带来良好的生存结果。
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