Tzivanakis Alexios, Moran Brendan J
Peritoneal Malignancy Institute, Basingstoke, Hampshire, United Kingdom.
Clin Colon Rectal Surg. 2020 Sep;33(5):247-252. doi: 10.1055/s-0040-1713741. Epub 2020 Jul 20.
The majority of patients with colorectal tumors will present via the elective route. However, one-fifth of patients will present as an emergency. The most common cause of emergency presentation of colorectal cancer is obstruction followed by perforation, and in many cases, patients will present with both. We discuss the management of the patient presenting with a perforated colorectal tumor covering the acute presentation and also how to deal with consequences of a perforated tumor, namely, the management of colorectal peritoneal metastasis (CPM). CPM used to be considered a terminal condition; however, a strategy of early detection of CPM, careful patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, leads to much improved outcomes and even cure, in some patient compared with systemic chemotherapy alone.
大多数结直肠肿瘤患者会通过择期途径就诊。然而，五分之一的患者会以急症形式就诊。结直肠癌急症就诊最常见的原因是梗阻，其次是穿孔，而且在很多情况下，患者会同时出现这两种情况。我们讨论以结直肠肿瘤穿孔形式就诊患者的管理，涵盖急性表现以及如何处理穿孔肿瘤的后果，即结直肠腹膜转移（CPM）的管理。CPM过去曾被认为是终末期疾病；然而，早期检测CPM、仔细选择适合细胞减灭术和腹腔内热化疗的患者的策略，与单纯全身化疗相比，能使部分患者的预后得到显著改善，甚至实现治愈。
