Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
Department of Surgical Oncology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.
Clin Exp Metastasis. 2021 Apr;38(2):187-196. doi: 10.1007/s10585-021-10074-2. Epub 2021 Jan 24.
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis, particularly for patients with metastatic disease. Treatment for oligometastatic presentation has been reported in recent literature, but the role of intraperitoneal chemotherapy for patients with peritoneal metastases (PM) remains unclear. We performed a systematic literature search of the PubMed, Cochrane and Embase databases in order to identify clinical trials and case-series reporting on the safety and efficacy of intraperitoneal chemotherapy in patients with PDAC-derived PM. Eight publications reporting on 85 patients were identified, using three different therapeutic strategies. First, 37 patients received cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for PDAC with PM. Grade 3 and 4 complications occurred in 37.8% of patients, without perioperative mortality. Median disease-free survival and overall survival (OS) rates varied from 4 to 36 months and 4 to 62 months, respectively. Secondly, 40 patients with resectable PDAC without PM received prophylactic HIPEC following pancreatic resection, with postoperative morbidity and mortality rates of 30% and 5%, and 5-year OS rates of 23-24%. Finally, eight patients with PDAC-derived peritoneal disease were converted to resectable disease after receiving neoadjuvant intraperitoneal chemotherapy and operated on with curative intent, achieving a median OS of 27.8 months. In conclusion, CRS with HIPEC for PDAC-derived PM appears to be safe, conferring the same postoperative morbidity and mortality as reported on non-pancreatic malignancies. In highly selected patients, it could be considered for short-term disease control. However, long-term survival remains poor. The addition of prophylactic HIPEC for resectable PDAC cannot be recommended.
胰腺导管腺癌（PDAC）是一种侵袭性恶性肿瘤，预后较差，尤其是对于转移性疾病的患者。最近的文献中有关于寡转移表现的治疗报道，但对于腹膜转移（PM）患者腹腔内化疗的作用仍不清楚。我们对 PubMed、Cochrane 和 Embase 数据库进行了系统的文献检索，以确定报告 PDAC 来源的 PM 患者腹腔内化疗安全性和疗效的临床试验和病例系列研究。使用三种不同的治疗策略，确定了 8 项报告 85 例患者的出版物。首先，37 例患者接受了 PDAC 伴 PM 的细胞减灭术（CRS）联合腹腔内热化疗（HIPEC）。37.8%的患者出现 3 级和 4 级并发症，无围手术期死亡。无复发生存和总生存（OS）率分别为 4 至 36 个月和 4 至 62 个月。其次，40 例无 PM 的可切除 PDAC 患者在胰腺切除术后接受预防性 HIPEC，术后发病率和死亡率为 30%和 5%，5 年 OS 率为 23-24%。最后，8 例 PDAC 来源的腹膜疾病患者在接受新辅助腹腔内化疗后转化为可切除疾病，并进行了治愈性手术，中位 OS 为 27.8 个月。总之，CRS 联合 HIPEC 治疗 PDAC 来源的 PM 似乎是安全的，其术后发病率和死亡率与非胰腺恶性肿瘤报道的相似。在高度选择的患者中，可以考虑短期疾病控制。然而，长期生存仍然较差。不能推荐预防性 HIPEC 用于可切除的 PDAC。
