Cortes-Guiral Delia, Glehen Olivier
General Surgery Department, Principe de Asturias University Hospital, Carretera de Alcala s/n, Alcalá de Henares, Madrid, Spain.
General Surgery Department (Surgical Oncology), Centre Hospitalier Lyon Sud (Hospices Civils de Lyon), Lyon, France.
Clin Colon Rectal Surg. 2020 Sep;33(5):253-257. doi: 10.1055/s-0040-1713742. Epub 2020 Sep 18.
Locally advanced colorectal cancer is a challenge for surgeons and medical oncologist; 10 to 20% colorectal cancer debut as locally advanced disease, with tumors extending through the colon wall with perforation and/or invasion of adjacent organs or structures. Those locally advanced tumors have a worse prognostic at any stage due not only to systemic dissemination but also in a high percentage of patients, to locoregional recurrence, in fact, peritoneal carcinomatosis of colorectal origin is so predictable that we can assess the risk for each patient according to some histopathological and clinical features: small peritoneal nodules resected in the first surgery (70% probability), ovarian metastases (60%), perforated tumor onset or intraoperative tumor rupture (50%), positive cytology (40%), and pT4/mucinous pT3 up to 40%. Prophylactic or adjuvant hyperthermic intraperitoneal chemotherapy seems to be a promising strategy for patients with advanced colorectal cancer to prevent the development of peritoneal recurrence and improve prognosis of this group of patients.
局部进展期结直肠癌对外科医生和肿瘤内科医生来说是一项挑战；10%至20%的结直肠癌初诊时即为局部进展期疾病，肿瘤穿透结肠壁并伴有穿孔和/或侵犯相邻器官或结构。这些局部进展期肿瘤在任何阶段的预后都较差，这不仅是由于全身播散，还因为在很大比例的患者中会出现局部区域复发。事实上，结直肠癌起源的腹膜癌转移是如此可预测，以至于我们可以根据一些组织病理学和临床特征评估每位患者的风险：首次手术切除的小腹膜结节（70%的概率）、卵巢转移（60%）、肿瘤穿孔性发病或术中肿瘤破裂（50%）、阳性细胞学检查（40%）以及pT4/黏液性pT3高达40%。预防性或辅助性腹腔内热化疗似乎是晚期结直肠癌患者预防腹膜复发和改善该组患者预后的一种有前景的策略。
