Xu Y, Wang Z N
Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang 110001, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2023 May 25;26(5):414-418. doi: 10.3760/cma.j.cn441530-20230301-00059.
Peritoneal metastasis is one of the most frequent patterns of metastasis in gastric cancer, and remains a major unmet clinical problem. Thus, systemic chemotherapy remains the mainstay of treatment for gastric cancer with peritoneal metastasis. In well-selected patients, the reasonable combination of cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), and neoadjuvant intraperitoneal chemotherapy with systemic chemotherapy will bring significant survival benefits to patients with gastric cancer peritoneal metastasis. In patients with high-risk factors, prophylactic therapy may reduce the risk of peritoneal recurrence, and improves survival after radical gastrectomy. However, high-quality randomized controlled trials will be needed to determine which modality is better. The safety and efficacy of intraoperative extensive intraperitoneal lavage as a preventive measure has not been proven. The safety of HIPEC also requires further evaluation. HIPEC and neoadjuvant intraperitoneal and systemic chemotherapy have achieved good results in conversion therapy, and it is necessary to find more efficient and low-toxicity therapeutic modalities and screen out the potential benefit population. The efficacy of CRS combined with HIPEC on peritoneal metastasis in gastric cancer has been preliminarily validated, and with the completion of clinical studies such as PERISCOPE II, more evidence will be available.
腹膜转移是胃癌最常见的转移模式之一，仍然是一个主要的未满足的临床问题。因此，全身化疗仍然是胃癌伴腹膜转移治疗的主要手段。在精心挑选的患者中，减瘤手术、热灌注腹腔化疗（HIPEC）以及新辅助腹腔化疗与全身化疗的合理联合，将给胃癌腹膜转移患者带来显著的生存获益。在有高危因素的患者中，预防性治疗可能降低腹膜复发风险，并提高根治性胃切除术后的生存率。然而，需要高质量的随机对照试验来确定哪种治疗方式更好。术中广泛腹腔灌洗作为一种预防措施的安全性和有效性尚未得到证实。HIPEC的安全性也需要进一步评估。HIPEC和新辅助腹腔及全身化疗在转化治疗中取得了良好效果，有必要寻找更高效、低毒的治疗方式，并筛选出潜在受益人群。CRS联合HIPEC对胃癌腹膜转移的疗效已得到初步验证，随着PERISCOPE II等临床研究的完成，将有更多证据。
