Advanced gastric cancer with or without peritoneal carcinomatosis treated with hyperthermic intraperitoneal chemotherapy: A single western center experience
Advanced gastric cancer with or without peritoneal carcinomatosis treated with hyperthermic intraperitoneal chemotherapy: A single western center experience
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DOI：
10.1016/j.ejso.2007.12.003
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发表时间：
2008-11-01
期刊：
影响因子：
3.8
通讯作者：
Msika, S.
中科院分区：
文献类型：
--
作者：
Scaringi, S.;Kianmanesh, R.;Msika, S.
简介：本文的目的是评估温热腹腔化疗（HIPEC），联合或不联合肿瘤细胞减灭术（CS）在治疗不同阶段的进展期胃癌（AGC）的作用。患者和方法：37例AGC患者接受了43 HIPEC从1992年6月至2007年2月。HIPEC使用丝裂霉素-C和顺铂在41-43 ℃的腹腔内温度下持续60-90分钟。主要终点是长期生存率，发病率和死亡率rises.Results：11例患者没有明显的PC迹象，构成预防组，而26例患者有宏观PC（PC组）。5例患者为Gilly 1或2（结节= 0.5 cm）。在PC组中，8例患者（PC治愈亚组）在HIPEC前实现了完全治愈CS，18例患者（PC姑息亚组）在HIPEC前实现了姑息CS。总体30天死亡率为5%（2例患者）。预防组中有2例患者在出院后6个月内死亡（总死亡率为11%）。每例手术的估计死亡风险为9%。10名患者（27%）出现了一种或多种并发症。预防组的中位生存期为23.4个月，PC组为6.6个月（p < 0.05）。PC治愈亚组的中位生存期为15个月，PC姑息亚组为3.9个月（p = 0.007）。根据Gilly分类的中位生存期有显著差异（Gilly 1和2与Gilly 3和4，分别为15个月与4个月，p = 0.014）。预防组和PC治愈亚组2年时的总体复发率分别为36%和50%。中位复发延迟时间分别为18.5个月和9.7个月。结论：HIPEC可能是有用的，以提高生存在选定的ACG患者时，完全细胞减灭可以实现。尽管有令人鼓舞的数据，但需要基于更大患者队列的前瞻性研究来评估该手术作为AGC患者预防性治疗的作用。(C)2007爱思唯尔有限公司保留所有权利。
Introduction: The aim of this article was to evaluate the role of hyperthermic intraperitoneal chemotherapy (HIPEC), associated or not to cytoreductive surgery (CS) in the treatment of different stages of advanced gastric cancer (AGC).Patients and methods: Thirty seven patients with AGC who underwent 43 HIPEC from June 1992 to February 2007 were included. HIPEC used Mitomycin-C and Cisplatin for 60-90 min at 41-43 degrees C intra-abdominal temperature. The main endpoints were long-term survivals, morbidity and mortality rates.Results: Eleven patients had no demonstrable sign of PC and constituted the Prophylactic-group, while 26 patients had macroscopic PC (PC-group). Five patients were Gilly 1 or 2 (nodules = 0.5 cm). In the PC-group a complete curative CS was achieved before HIPEC in 8 (PC-curative subgroup) and a palliative HIPEC in 18 patients (PC-palliative subgroup). The overall 30-days mortality was 5% (2 patients). Two patients in the Prophylactic group died within 6 months after hospital discharge (overall mortality 11%). The estimated risk of death per procedure was 9%. Ten patients (27%) presented one or more complications. The median survival was 23.4 months in the Prophylactic group, and 6.6 months in the PC-group (p < 0.05). The median survival in the PC-curative subgroup was 15 vs 3.9 months in the PC-palliative subgroup (p = 0.007). The median survival according to Gilly classification was significantly different (Gilly 1&2 vs Gilly 3&4, 15 vs 4 months respectively, p = 0.014). The global recurrence rates between the Prophylactic group and the PC-curative subgroup at 2 years were 36% vs 50% respectively. The median delay to recurrence was 18.5 vs 9.7 months respectively.Conclusion: HIPEC might be useful to improve the survival in selected patients with ACG only when a complete cytoreduction can be achieved. Despite encouraging data, prospective studies, based on larger cohorts of patients are required to assess the role of this procedure as a prophylactic treatment in patients with AGC. (C) 2007 Elsevier Ltd. All rights reserved.