Ji C H, Zhou L L, Yang Y B, Hu J Q, Wei H R, Dong F H, Shan Y Q, Kong W C
The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, China.
Department of Gastroenterological and Anorectal Surgery, Hangzhou First People´s Hospital, Hangzhou 310006, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2024 Jul 25;27(7):740-748. doi: 10.3760/cma.j.cn441530-20230831-00076.
Peritoneal metastasis in gastric cancer is associated with rapid disease progression. Hyperthermic intraoperative peritoneal chemotherapy (HIPEC) done immediately after cytoreductive surgery (CRS) has become an important treatment for peritoneal metastasis in gastric cancer patients. However, different treatment options for HIPEC exist with potential influence on survival rates and prognosis in patients, exist. These treatment options include open or closed abdomen technique, perfusion solution, number of catheters, temperature, duration, and drug regimens. This paper aims to provide more evidence on standardization of HIPEC treatment options and technologies by systematically reviewing different drug regimens and technical approaches. The study included 2 randomized controlled trials, 3 phase I/II clinical trials, 2 prospective cohort studies, and 34 retrospective cohort studies, involving 1511 patients. The most common HIPEC option is to dissolve 50-75 mg/m of Cisplatin and 30-40 mg/m of Mitomycin C in 3-4 L saline solution at 42-43℃. After gastrointestinal anastomosis, 2-3 catheters are used in the HIPEC system with a perfusion flow rate of 500 ml/min. The duration is 60-90 minutes. Anastomotic leakage was low in studies where HIPEC was performed after gastrointestinal anastomosis. The utilization of open HIPEC and a two-drug regimen resulted in improved overall survival rates. The future development of HIPEC aims to enhance tumor-specific therapy by optimizing various aspects, such as identifying the safest and most effective chemotherapy regimens, refining patient selection criteria, and improving perioperative care.
胃癌腹膜转移与疾病快速进展相关。在肿瘤细胞减灭术（CRS）后立即进行的术中热灌注化疗（HIPEC）已成为胃癌腹膜转移患者的重要治疗方法。然而，HIPEC存在不同的治疗选择，可能会对患者的生存率和预后产生影响。这些治疗选择包括开腹或关腹技术、灌注液、导管数量、温度、持续时间和药物方案。本文旨在通过系统回顾不同的药物方案和技术方法，为HIPEC治疗选择和技术的标准化提供更多证据。该研究纳入了2项随机对照试验、3项I/II期临床试验、2项前瞻性队列研究和34项回顾性队列研究，涉及1511例患者。最常见的HIPEC方案是在3-4升盐溶液中，于42-43℃溶解50-75mg/m的顺铂和30-40mg/m的丝裂霉素C。胃肠吻合术后，在HIPEC系统中使用2-3根导管，灌注流速为500ml/min。持续时间为60-90分钟。在胃肠吻合术后进行HIPEC的研究中，吻合口漏发生率较低。采用开放式HIPEC和两药方案可提高总生存率。HIPEC的未来发展旨在通过优化各个方面来加强肿瘤特异性治疗，如确定最安全、最有效的化疗方案、完善患者选择标准以及改善围手术期护理。
