Asian School of Peritoneal Surface Malignancy Treatment, Kishiwada Tokushukai Hospital.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1723-1726.
In 1998, the Peritoneal Surface Oncology Group International(PSOGI)proposed a novel treatment referred to as comprehensive treatment(COMPT). COMPT involves the complete removal of macroscopic tumors(cytoreductive surgery: CRS) and eradication of micrometastasis(MM)with neoadjuvant chemotherapy(NAC)plus intraoperative hyperthermic intraperitoneal chemotherapy(HIPEC). This article provides a rationale for curative COMPT. Additionally, based on our experience, the selection criteria for treatment will be clarified.
The residual cancer cell burden is lowest immediately following CRS, and intraoperative HIPEC plays a crucial role in the treatment of patients with peritoneal surface malignancy (PSM). COMPT will fail if the number of the MM remaining after CRS exceeds the limit of complete eradication by intraoperative HIPEC(threshold). However, if the residual number of MM is less than the threshold, patients will respond positively to treatment.
To validate the direct effect of HIPEC, laparoscopic HIPEC(LHIPEC)was performed, and changes in the peritoneal cancer index(PCI)were then evaluated. Complete cytoreduction and HIPEC carried out based on the concept of COMPT was performed in 171 gastric cancer(GC)patients with PCI≤12, 183 colorectal cancer(CRC)with PCI≤21 and 460 pseudomyxoma peritonei(PMP)patients with PCI≤28. The postoperative survivals rates were then analyzed.
After 1 cycle of LHIPEC, PCIs in GC and PMP were significantly reduced by 1.85 and 2.7 1 month after LHIPEC. However, PCI of CRC increased. Positive cytology at LHIPEC became negative in 57.6%, 42.9% and 60.9% of patients with GC, CRC and PMP, respectively. Median survival time(MST)for GC and CRC was 21.2 and 71.5 months, respectively MST of PMP was not reached. MST of PMP was not reached. Ten-year survival rates were 12.6%, 21.7% and 81.6%, respectively. Grade 5 complications for each disease were 0.8%, 1.0% and 1.1%, respectively.
Complete cytoreductive surgery combined with intraoperative HIPEC may improve the long-term survival of patients with PSM who have PCIs less than the threshold levels, by keeping the mortality rates after CRS plus intraoperative HIPEC within acceptable levels.
1998 年，腹膜表面肿瘤国际组织（PSOGI）提出了一种新的治疗方法，称为综合治疗（COMPT）。COMPT 包括完全切除肉眼可见肿瘤（细胞减灭术：CRS）和新辅助化疗（NAC）联合术中腹腔热灌注化疗（HIPEC）根除微转移（MM）。本文提供了根治性 COMPT 的基本原理。此外，根据我们的经验，将阐明治疗的选择标准。
CRS 后，残留癌细胞负担最低，术中 HIPEC 在腹膜表面恶性肿瘤（PSM）的治疗中起着至关重要的作用。如果 CRS 后 MM 的数量超过术中 HIPEC 完全消除的极限（阈值），则 COMPT 将失败。然而，如果 MM 的残留数量小于阈值，患者将对治疗有积极反应。
为了验证 HIPEC 的直接作用，进行了腹腔镜 HIPEC（LHIPEC），然后评估了腹膜癌指数（PCI）的变化。根据 COMPT 的概念，对 171 例 PCI≤12 的胃癌（GC）患者、183 例 PCI≤21 的结直肠癌（CRC）患者和 460 例假性黏液瘤腹膜（PMP）患者进行了完全减瘤术和 HIPEC。然后分析术后生存率。
LHIPEC 后 1 个周期，GC 和 PMP 的 PCI 分别在 LHIPEC 后 1 个月和 2.7 个月时显著降低 1.85。然而，CRC 的 PCI 增加。GC、CRC 和 PMP 患者的 LHIPEC 阳性细胞学结果分别转为阴性的比例为 57.6%、42.9%和 60.9%。GC 和 CRC 的中位生存时间（MST）分别为 21.2 个月和 71.5 个月，而 PMP 的 MST 未达到。PMP 的 10 年生存率分别为 12.6%、21.7%和 81.6%。每种疾病的 5 级并发症发生率分别为 0.8%、1.0%和 1.1%。
对于 PCI 低于阈值的 PSM 患者，完全细胞减灭术联合术中 HIPEC 可能通过将 CRS 加术中 HIPEC 后的死亡率保持在可接受水平，从而提高患者的长期生存率。
