Department of Gastrointestinal Surgery, University of Health Sciences, Kosuyolu Yuksek Ihtisas Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, SBU, Bursa Yuksek Ihtisas EAH, Mimar Sinan Mahallesi, Emniyet Caddesi, 16310, Yildirim, Bursa, Turkey.
Langenbecks Arch Surg. 2022 May;407(3):1201-1207. doi: 10.1007/s00423-021-02386-4. Epub 2021 Nov 29.
The hepatic bridge as an anatomical variation may lead to recurrence and treatment failure in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by constituting an obscure region during surgery. This report aimed to highlight the relationship between the hepatic bridge and various prognostic factors in peritoneal carcinomatosis.
Data of 101 patients who underwent CRS/HIPEC for peritoneal carcinomatosis in a single centre were retrospectively reviewed. Demographic characteristics, primary origin of peritoneal carcinomatosis, classification of hepatic bridge, Peritoneal Cancer Index (PCI) score, and completeness of cytoreduction (CC) score were analysed.
The tumour was proven histopathologically in 18 (28.6%) of 63 patients who underwent distal round ligament (DRL) resection. The PCI score was found to be significantly higher in patients with tumour in DRL compared to the ones without tumour (p < 0.001). The median PCI score of patients with implant positive DRL was 18 (12-20) and this score was 3 (2-6) for patients with implant negative DRL (p < 0.001). The ROC curve concerning the risk of an implant penetrating the round ligament revealed the optimal cut-off value of PCI at 10 with 88.9% sensitivity and 79.3% specificity.
The round ligament should be removed, regardless of the PCI score, as a standard in mucinous adenocarcinoma of the appendix and malignant peritoneal mesothelioma. DRL should be removed when PCI is equal or higher than 10 for PC due to colorectal and ovarian cancers.
肝桥作为一种解剖变异，可能会导致细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）的复发和治疗失败，因为它在手术中构成了一个模糊区域。本报告旨在强调肝桥与腹膜癌病各种预后因素之间的关系。
回顾性分析了 101 例在单中心接受 CRS/HIPEC 治疗的腹膜癌病患者的数据。分析了人口统计学特征、腹膜癌病的原发来源、肝桥的分类、腹膜癌指数（PCI）评分和细胞减灭术（CC）的完全程度。
在 63 例行远端圆韧带（DRL）切除术的患者中，有 18 例（28.6%）的肿瘤经组织病理学证实。与无肿瘤患者相比，肿瘤存在于 DRL 的患者的 PCI 评分明显更高（p<0.001）。DRL 种植阳性患者的中位 PCI 评分为 18（12-20），而 DRL 种植阴性患者的 PCI 评分为 3（2-6）（p<0.001）。关于种植物穿透圆韧带风险的 ROC 曲线显示，PCI 的最佳截断值为 10，灵敏度为 88.9%，特异性为 79.3%。
在阑尾黏液性腺癌和恶性腹膜间皮瘤中，无论 PCI 评分如何，圆韧带都应作为标准被切除。对于结直肠和卵巢癌引起的 PC，当 PCI 等于或高于 10 时，应切除 DRL。
