Jacquet P, Jelinek J S, Chang D, Koslowe P, Sugarbaker P H
Gastrointestinal Oncology Section, Washington Hospital Center, Washington, D.C. 20010, USA.
J Am Coll Surg. 1995 Dec;181(6):530-8.
Cytoreductive surgery and intraperitoneal chemotherapy have been used to treat peritoneal carcinomatosis. A complete surgical resection is required for optimal results to be achieved. This study evaluated the preoperative computed tomographic (CT) findings in patients with mucinous peritoneal carcinomatosis in order to predict the probability of a complete resection.
Computed tomographic scans of the abdomen and pelvis were reviewed retrospectively in 45 patients with a diagnosis of mucinous peritoneal carcinomatosis who were treated with surgery and intraperitoneal chemotherapy. According to the completeness of cytoreduction, patients were divided into two groups. Patients in the first group (n = 25) had complete cytoreduction (CR) with no tumor deposits 2.5 mm in diameter or larger left behind. The surgical resection of tumor was incomplete in the second group of patients (n = 20). Sixteen CT parameters were initially examined in each group of patients and statistically evaluated according to the completeness of the cytoreductive surgical procedure.
The incidences of six CT findings were significantly different in the two groups of patients. These findings were: tumor volume in small bowel mesentery (p < 0.001), tumor volume in proximal jejunum (p = 0.003), tumor volume in distal jejunum (p = 0.002), tumor volume in proximal ileum (p = 0.003), mesentery configuration (p < 0.001), and obstruction of bowel segments by tumor (p < 0.001). A statistical approach using a tree-structured diagram showed that patients with both obstruction of bowel segments by tumor and tumor diameter greater than 0.5 cm on small bowel surfaces exclusive of distal ileum on preoperative CT scan, had an 88 percent probability of incomplete resection. Patients without these two CT findings had a 92 percent probability of complete resection.
This study shows that selection criteria for patients with mucinous peritoneal carcinomatosis are available on a preoperative CT scan of the abdomen and pelvis. Patients whose scans show obstruction of bowel segments by tumor and tumor diameter greater than 0.5 cm on small bowel surfaces exclusive of distal ileum are unlikely to be candidates for cytoreductive surgery for the treatment of peritoneal carcinomatosis.
细胞减灭术和腹腔内化疗已被用于治疗腹膜癌病。为获得最佳疗效，需要进行完整的手术切除。本研究评估了黏液性腹膜癌病患者的术前计算机断层扫描（CT）结果，以预测完整切除的可能性。
回顾性分析了45例诊断为黏液性腹膜癌病并接受手术和腹腔内化疗患者的腹部和盆腔CT扫描。根据细胞减灭的完整性，将患者分为两组。第一组（n = 25）患者实现了完全细胞减灭（CR），术后无直径2.5毫米或更大的肿瘤残留。第二组（n = 20）患者的肿瘤手术切除不完整。最初在每组患者中检查了16项CT参数，并根据细胞减灭手术的完整性进行了统计学评估。
两组患者中六项CT表现的发生率存在显著差异。这些表现为：小肠系膜肿瘤体积（p < 0.001）、空肠近端肿瘤体积（p = 0.003）、空肠远端肿瘤体积（p = 0.002）、回肠近端肿瘤体积（p = 0.003）、系膜形态（p < 0.001）以及肿瘤导致的肠段梗阻（p < 0.001）。使用树形图的统计方法显示，术前CT扫描显示肿瘤导致肠段梗阻且小肠表面（不包括回肠远端）肿瘤直径大于0.5厘米的患者，不完全切除的概率为88%。没有这两项CT表现的患者完全切除的概率为92%。
本研究表明，黏液性腹膜癌病患者的选择标准可通过术前腹部和盆腔CT扫描获得。扫描显示肿瘤导致肠段梗阻且小肠表面（不包括回肠远端）肿瘤直径大于0.5厘米的患者不太可能成为细胞减灭术治疗腹膜癌病的候选者。
