Spiliotis John, Kopanakis Nikolaos, Terra Alexios, Iavazzo Christos, Prodromidou Anastasia, Rogdakis Athanasios, Efstathiou Elias
Department of Surgical Oncology and HIPEC, Athens Medical Centre, Athens, Greece.
J BUON. 2021 Jul-Aug;26(4):1669-1678.
Peritoneal spread of neoplastic diseases is considered a fatal condition with a dismal prognosis. Few therapeutic options were offered to these patients and surgery had only palliative character. However, advances in surgical techniques and new drugs development, have changed the management of this terminal stage disease. Cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC), has been proposed as a promising alternative to palliative surgery and systemic chemotherapy, since 1980s. Many changes through all these years have refined the technique and standardized indications and limits.
A retrospective study was performed in our medical records, of all patients treated with CRS and HIPEC since 2006. Survival, complications and prognostic factors were studied in a total of 632 patients.
Female patients were 419 and males were 213. Mean age was 52.6 years. Peritoneal metastases secondary to colorectal cancer were the most frequent treated disease (87 patients), whereas hepatobilliary-pancreatic neoplastic diseases and sarcomas were the less frequent causes of peritoneal carcinomatosis. Patients with peritoneal metastases from ovarian cancer, treated with systemic chemotherapy and then received interval cytoreductive surgery with HIPEC, were the largest group that are still alive (43%), while only 35% of patients with hepatobilliary-pancreatic cancer and peritoneal disease are alive at present. Gender, age, peritoneal cancer index (PCI), completeness of cytoreduction score (CCs), and number of complications were important prognostic factors of overall survival.
Peritoneal carcinomatosis is still considered a final stage disease with a poor prognosis. The confinement of the neoplastic disease in the peritoneal cavity has led to the development of local therapies with promising results. CRS and HIPEC have evolved significantly over the past several years and are at the present the most valuable treatment in highly selected patients with peritoneal carcinomatosis.
肿瘤疾病的腹膜播散被认为是一种预后极差的致命情况。这些患者几乎没有治疗选择，手术仅具有姑息性质。然而，手术技术的进步和新药的研发改变了这种终末期疾病的治疗方式。自20世纪80年代以来，减瘤手术（CRS）联合腹腔热灌注化疗（HIPEC）已被提出作为姑息性手术和全身化疗的一种有前景的替代方案。这些年来的许多变化完善了该技术，并规范了适应证和局限性。
对自2006年以来接受CRS和HIPEC治疗的所有患者的病历进行回顾性研究。共对632例患者的生存情况、并发症和预后因素进行了研究。
女性患者419例，男性患者213例。平均年龄为52.6岁。结直肠癌继发的腹膜转移是最常见的治疗疾病（87例），而肝胆胰肿瘤疾病和肉瘤是腹膜癌转移较少见的原因。接受全身化疗后再接受间歇性减瘤手术联合HIPEC治疗的卵巢癌腹膜转移患者是仍存活的最大群体（43%），而目前肝胆胰癌伴腹膜疾病患者中只有35%存活。性别、年龄、腹膜癌指数（PCI）、减瘤评分完整性（CCs）和并发症数量是总生存的重要预后因素。
腹膜癌转移仍被认为是一种预后不良的终末期疾病。肿瘤局限于腹膜腔促使了局部治疗的发展并取得了有前景的结果。CRS和HIPEC在过去几年中有了显著发展，目前是高度选择的腹膜癌转移患者最有价值的治疗方法。
