Zhang W H, Hu J K
Department of Gastrointestinal Surgery, Laboratory of Gastric Cancer, West China Hospital, Sichuan University, Chengdu 610041, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2021 Mar 25;24(3):204-207. doi: 10.3760/cma.j.cn.441530-20201116-00611.
Peritoneal metastasis is the most common distant metastasis of gastric cancer. As an end-stage event of gastric cancer, patients with peritoneal metastasis often have lost the chance of radical resection, and even after palliative surgical resection, the long-term outcomes are still not satisfactory. In recent years, with the application and promotion of laparoscopic technology, neoadjuvant intraperitoneal and systemic chemotherapy, hyperthermic intraperitoneal chemotherapy and cytoreductive surgery, through perioperative comprehensive treatment strategies by multidisciplinary team, the quality of life and survival of patients with peritoneal metastasis have been significantly improved. Some patients with gastric cancer peritoneal metastasis diagnosed by laparoscopy even get the opportunity to have radical cytoreductive surgery and hyperthermic intraperitoneal chemotherapy after neoadjuvant intraperitoneal and systemic chemotherapy. Taking into account the progress in the treatment of gastric cancer peritoneal metastasis in recent years, this article intends to combine current clinical evidence and to discuss the key issues in the course of clinical diagnosis and treatment of gastric cancer peritoneal implantation and metastasis, including the imaging diagnosis of peritoneal metastasis, laparoscopic examination, evaluation of peritoneal metastasis and comprehensive treatment plan.
腹膜转移是胃癌最常见的远处转移。作为胃癌的终末期事件，腹膜转移患者往往失去了根治性切除的机会，即使进行姑息性手术切除，长期预后仍不尽人意。近年来，随着腹腔镜技术、新辅助腹腔及全身化疗、腹腔热灌注化疗和减瘤手术的应用与推广，通过多学科团队的围手术期综合治疗策略，腹膜转移患者的生活质量和生存率得到了显著提高。一些经腹腔镜诊断为胃癌腹膜转移的患者，在接受新辅助腹腔及全身化疗后，甚至有机会接受根治性减瘤手术和腹腔热灌注化疗。鉴于近年来胃癌腹膜转移治疗的进展，本文旨在结合当前临床证据，探讨胃癌腹膜种植转移临床诊治过程中的关键问题，包括腹膜转移的影像学诊断、腹腔镜检查、腹膜转移的评估及综合治疗方案。
