Peritoneal carcinomatosis of colorectal origin - Incidence and current treatment strategies
Peritoneal carcinomatosis of colorectal origin - Incidence and current treatment strategies
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DOI：
10.1097/01.sla.0000197702.46394.16
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发表时间：
2006-02-01
影响因子：
9
通讯作者：
Bleichrodt, RP
中科院分区：
文献类型：
--
作者：
Koppe, MJ;Boerman, OC;Bleichrodt, RP
目的：回顾有关原发性结直肠癌（CRC）手术期间腹膜种植的发生率和预后意义、CRC腹膜内复发的发生率以及结直肠原发性PC的当前治疗策略的文献，特别关注细胞减灭术和腹膜内化疗（IPEC）。虽然血行播散对CRC患者构成最大的威胁，但腹膜癌病（PC）可能是由癌细胞的腹膜内种植引起的，在复发性CRC患者中是相对频繁的事件。在PubMed和Medline文献数据库中检索关于原发性CRC的根治性手术期间腹膜腔内脱落的肿瘤细胞的发生率和预后意义、CRC腹膜内复发的发生率、以及IPEC后全身化疗或细胞减灭术的治疗结果。结果：在12个患者系列中报告的原发性CRC潜在治愈性手术中腹膜种植的发生率差异很大，从3%到28%，这可能是由于检测肿瘤细胞的方法不同。在初次手术时约有7%的患者发生PC，在根治性手术后随访期间约有4%至19%的患者发生PC，在需要再次剖腹手术的复发性CRC患者中高达44%，在死于CRC的患者中为40%至80%。据报道，以5-氟尿嘧啶为基础的全身化疗后PC的中位生存期为5.2至12.6个月。在选定的患者中，如16个患者系列中所报告的，在积极的细胞减灭术后（热）IPEC的中位生存期往往更好，从12个月到32个月不等，发病率和死亡率分别为14%至55%和0%至19%。一项随机对照试验已发表证实积极的手术cytoreduction和腹腔化疗严格姑息treatment.Conclusions的优越性：腹膜种植的癌细胞可能导致PC是一个相当常见的现象，在CRC患者。细胞减灭术和辅助（热）IPEC已被证明是有效的，在选定的患者，因此应考虑在可切除的PC结直肠起源的患者。
Objective: To review the literature with regard to the incidence and prognostic significance of peritoneal seeding during surgery for primary colorectal cancer (CRC), the incidence of intraperitoneal recurrence of CRC, and the current treatment strategies of established PC of colorectal origin, with special focus on cytoreductive surgery and intraperitoneal chemotherapy (IPEC).Summary Background Data: Although hematogenous dissemination forms the greatest threat to patients with CRC, peritoneal carcinomatosis (PC), presumably arising from intraperitoneal seeding of cancer cells, is a relatively frequent event in patients with recurrent CRC.Methods: The PubMed and Medline literature databases were searched for pertinent publications regarding the incidence and prognostic significance of exfoliated tumor cells in the peritonea] cavity during curative surgery for primary CRC, the incidence of intraperitoneal recurrence of CRC, and the therapeutic results of systemic chemotherapy or cytoreductive surgery followed by IPEC.Results: The incidence of peritonea] seeding during potentially curative surgery for primary CRC, as reported in 12 patient series, varied widely, from 3% to 28%, which may be explained by differences in methods to detect tumor cells. PC is encountered in approximately 7% of patients at primary surgery, in approximately 4% to 19% of patients during follow-up after curative surgery, in up to 44% of patients with recurrent CRC who require relaparotomy, and in 40% to 80% of patients who succumb to CRC. The reported median survival after systemic 5-fluorouracil-based chemotherapy for PC varies from 5.2 to 12.6 months. Median survival after aggressive cytoreductive surgery followed by (hyperthermic) IPEC in selected patients, as reported in 16 patient series, tends to be better and varies from 12 to 32 months at the cost of morbidity and mortality rates of 14% to 55% and 0% to 19%, respectively. One randomized controlled trial has been published confirming the superiority of aggressive surgical cytoreduction and intraperitoneal chemotherapy over strictly palliative treatment.Conclusions: Peritoneal seeding of cancer cells possibly leading to PC is a rather common phenomenon in patients with CRC. Cytoreductive surgery and adjuvant (hyperthermic) IPEC have been shown to be efficacious in selected patients and should therefore be considered in patients with resectable PC of colorectal origin.