胃癌和胃食管交界癌：根治性手术后预防腹膜复发的危险因素及预防性治疗
Gastric and gastroesophageal junction cancer: Risk factors and prophylactic treatments for prevention of peritoneal recurrence after curative intent surgery.
作者信息
Huang Biying, Rouvelas Ioannis, Nilsson Magnus
机构信息
Department of Upper Abdominal Diseases Karolinska University Hospital Stockholm Sweden.
Division of Surgery Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden.
出版信息
Ann Gastroenterol Surg. 2022 Mar 24;6(4):474-485. doi: 10.1002/ags3.12565. eCollection 2022 Jul.
AIM
Relapse after curative treatment for advanced gastric cancer, and especially peritoneal recurrence, is very common and has a dismal prognosis. The aim of this review is to summarize existing evidence regarding risk factors and prophylactic treatments intending to prevent peritoneal recurrence.
METHODS
A structured search of relevant studies was conducted in MEDLINE, Embase, and the Cochrane Library.
RESULTS
The main risk factors identified are advanced pathological T-stage (pT ≥ 3), regional lymph node involvement, diffuse/poorly cohesive type tumor, poorly differentiated cancer, and positive peritoneal wash cytology. Systemic chemotherapy in the perioperative or adjuvant setting improves survival for the patients but despite this peritoneal recurrence remains a common and yet an unsolved clinical problem. Different approaches of intraperitoneal chemotherapy such as hyperthermic intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy have shown promising results as prophylactic treatments aiming to prevent peritoneal recurrence.
CONCLUSION
Future studies are warranted to find safe and effective treatments to prevent peritoneal recurrence.
目的
晚期胃癌根治性治疗后的复发，尤其是腹膜复发，非常常见且预后不佳。本综述的目的是总结有关旨在预防腹膜复发的危险因素和预防性治疗的现有证据。
方法
在MEDLINE、Embase和Cochrane图书馆中对相关研究进行结构化检索。
结果
确定的主要危险因素为晚期病理T分期（pT≥3）、区域淋巴结受累、弥漫性/低黏附性肿瘤类型、低分化癌以及腹膜冲洗细胞学检查阳性。围手术期或辅助治疗中的全身化疗可提高患者生存率，但尽管如此，腹膜复发仍然是一个常见且尚未解决的临床问题。不同的腹腔内化疗方法，如热灌注腹腔内化疗和术后早期腹腔内化疗，作为预防腹膜复发的预防性治疗已显示出有前景的结果。
结论
有必要开展进一步研究以找到预防腹膜复发的安全有效的治疗方法。
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