Abdel Mageed Hisham, Van Der Speeten Kurt, Sugarbaker Paul
Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt. 27a Baghdad St., Korba, Heliopolis, Cairo, 11341, Egypt.
Department of Surgical Oncology, Schiepse Bos 6, Ziekenhuis Oost-Limburg. Genk, Belgium; Hasselt University. Diepenbeek, Belgium.
Surg Oncol. 2022 Mar;40:101676. doi: 10.1016/j.suronc.2021.101676. Epub 2021 Nov 27.
Cytoreductive surgery and intraperitoneal chemotherapy may offer chance for cure for patients with peritoneal metastasis. Many variations emerged, causing uncertainty when choosing the most suitable variant. By reviewing variability encountered in the management of peritoneal metastasis, we aim to raise awareness about this issue and hopefully initiate efforts to solve it. We review variance encountered in all aspects of this complex field of surgical oncology, indications, patient selection criteria, definition and extent of cytoreductive surgery and the numerous variables of intraperitoneal chemotherapy. Best benefit was achieved with pseudomyxoma peritonei, and to lesser extent in colorectal, ovarian and gastric cancer, but Indications keep expanding to include other tumors pathologies. Selection of patients depends on numerous prognostic indicators and criteria, according to tumor extent and pathology. The standard definition of cytoreductive surgery remains the same, but the boundaries of resection expand. Numerous chemotherapy regimens and administration methods are used, in search for best possible benefit. This variance must be reduced, to make the best use of, and further spread this treatment combination. Practical simple guidelines are needed for surgical oncologists willing to utilize this treatment for their patients, to be considered a true standard of care.
细胞减灭术和腹腔内化疗可能为腹膜转移患者提供治愈机会。出现了许多变体，在选择最合适的变体时造成了不确定性。通过回顾腹膜转移管理中遇到的变异性，我们旨在提高对这个问题的认识，并希望启动解决该问题的努力。我们回顾了这个复杂的外科肿瘤学领域各个方面遇到的差异，包括适应症、患者选择标准、细胞减灭术的定义和范围以及腹腔内化疗的众多变量。黏液性腹膜假瘤取得了最佳疗效，在结直肠癌、卵巢癌和胃癌中疗效稍差，但适应症不断扩大，包括其他肿瘤病理类型。根据肿瘤范围和病理情况，患者的选择取决于众多预后指标和标准。细胞减灭术的标准定义保持不变，但切除边界在扩大。为了寻求最佳效益，使用了多种化疗方案和给药方法。必须减少这种变异性，以充分利用并进一步推广这种治疗组合。对于愿意为患者采用这种治疗方法的外科肿瘤学家来说，需要实用的简单指南，才能将其视为真正的护理标准。
