Ayloor Seshadri Ramakrishnan, Sugarbaker Paul H, Saklani Avanish, Wexner Steven D
Department of Surgical Oncology, Cancer Institute, WIA, Chennai, India.
Program in Peritoneal Surface Malignancy, Washington Cancer Institute, Washington, DC, USA.
J Gastrointest Oncol. 2024 Oct 31;15(5):2305-2315. doi: 10.21037/jgo-24-258. Epub 2024 Sep 23.
Peritoneal metastases synchronously occurring in the patient with primary colon cancer causes that patient to be at high risk for subsequent disease progression within the abdomen and pelvis. If peritoneal metastases are preoperatively diagnosed, patients are likely to be treated with neoadjuvant chemotherapy with or without biological therapy prior to cytoreductive surgery (CRS). However, if one only considers patients with peritoneal metastases unexpectedly identified at the time of primary colon cancer resection, the optimal management strategy is neither standardized nor evidence based. These authors present an opinion regarding treatment options in unexpectedly (incidentally) detected peritoneal metastases. The primary colon cancer may be asymptomatic (elective list) or may present as an emergency with obstruction or with perforation. The fitness of the patient, the condition of the colon, availability of a colonic stent, consent of the patient and capabilities of the institution for management of peritoneal metastases by CRS and intraperitoneal chemotherapy cannot be ignored and must all be considered. These patients with known peritoneal metastases should not be allowed to return for further treatment with advanced disease after multiple regimens of systemic chemotherapy. Delay in definitive management will cause peritoneal metastases to be unresectable and not amenable to cure. It is time to debate optimal management strategies for unexpectedly detected peritoneal metastases. The authors find the data compelling that the modifications presented in the management of unexpected peritoneal metastases documented at the time of colon cancer resection changes a palliative approach to treatment to a plan that has curative intent.
原发性结肠癌患者同时发生的腹膜转移会使其腹部和盆腔后续疾病进展的风险升高。如果术前诊断出腹膜转移，患者可能会在减瘤手术（CRS）前接受新辅助化疗，可联合或不联合生物治疗。然而，如果仅考虑在原发性结肠癌切除时意外发现腹膜转移的患者，最佳管理策略既未标准化，也缺乏循证依据。本文作者针对意外（偶然）发现的腹膜转移提出了治疗方案的观点。原发性结肠癌可能无症状（择期手术），也可能因梗阻或穿孔而作为急症出现。患者的身体状况、结肠情况、结肠支架的可用性、患者的同意以及机构通过CRS和腹腔内化疗管理腹膜转移的能力都不能忽视，必须全部予以考虑。这些已知腹膜转移的患者不应在接受多种全身化疗方案后，带着晚期疾病回来接受进一步治疗。确定性治疗的延迟会导致腹膜转移无法切除且无法治愈。现在是时候讨论意外发现的腹膜转移的最佳管理策略了。作者发现有令人信服的数据表明，对结肠癌切除时记录的意外腹膜转移的管理进行调整，可将姑息性治疗方法转变为具有治愈意图的治疗方案。
