Peritoneal Carcinomatosis from Gastric Cancer: A Multi-Institutional Study of 159 Patients Treated by Cytoreductive Surgery Combined with Perioperative Intraperitoneal Chemotherapy
Peritoneal Carcinomatosis from Gastric Cancer: A Multi-Institutional Study of 159 Patients Treated by Cytoreductive Surgery Combined with Perioperative Intraperitoneal Chemotherapy
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DOI：
10.1245/s10434-010-1039-7
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发表时间：
2010-09-01
影响因子：
3.7
通讯作者：
Elias, Dominique
中科院分区：
文献类型：
--
作者：
Glehen, Olivier;Gilly, Francois Noel;Elias, Dominique
背景。胃癌引起的腹膜癌病（PC）长期以来被认为是中位生存期较短的绝症。细胞减灭术与围手术期腹腔化疗 (PIC) 相结合的新局部治疗方法已经发展并表明可以提高生存率。材料和方法。在法语中心进行了一项回顾性多中心研究，以评估毒性和主要预后因素，以确定最佳适应症。所有患者均接受细胞减灭术和PIC：腹腔热灌注化疗（HIPEC）和/或术后早期腹腔化疗（EPIC）。结果。该研究纳入了 1989 年 2 月至 2007 年 8 月期间来自 15 个机构的 159 名患者。中位随访时间为 20.4 个月。 HIPEC 是用于 150 个手术的 PIC。术后死亡率和 3-4 级发病率分别为 6.5% 和 27.8%。通过多变量分析，该机构对毒性有显着影响。总体中位生存期为 9.2 个月，1 年、3 年和 5 年生存率分别为 43%、18% 和 13%。多变量分析的唯一独立预后指标是细胞减灭术的完整性。对于接受完全细胞减灭术治疗的患者，中位生存期为15个月，1年、3年和5年生存率分别为61%、30%和23%。结论。细胞减灭术与 PIC 相结合治疗胃癌患者的治疗方法可能会在选定的一组患者（有限且可切除的 PC）中实现长期生存。高死亡率强调了这种必然的严格选择，应保留给参与 PC 和胃外科管理的经验丰富的机构。
Background. Peritoneal carcinomatosis (PC) from gastric cancer has long been regarded a terminal disease with a short median survival. New locoregional therapeutic approaches combining cytoreductive surgery with perioperative intraperitoneal chemotherapy (PIC) have evolved and suggest improved survival.Materials and Methods. A retrospective multicentric study was performed in French-speaking centers to evaluate the toxicity and the principal prognostic factors in order to identify the best indications. All patients had cytoreductive surgery and PIC: hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC).Results. The study included 159 patients from 15 institutions between February 1989 and August 2007. The median follow-up was 20.4 months. HIPEC was the PIC used for 150 procedures. Postoperative mortality and grade 3-4 morbidity rates were 6.5 and 27.8%, respectively. By multivariate analysis, the institution had a significant influence on toxicity. The overall median survival was 9.2 months and 1-, 3-, and 5-year survival rates were 43, 18, and 13%, respectively. The only independent prognostic indicator by multivariate analysis was the completeness of cytoreductive surgery. For patients treated by complete cytoreductive surgery, the median survival was 15 months with a 1-, 3-, and 5-year survival rate of 61, 30, and 23%, respectively.Conclusions. The therapeutic approach combining cytoreductive surgery with PIC for patients with gastric carcinomatosis may achieve long-term survival in a selected group of patients (limited and resectable PC). The high mortality rate underlines this necessarily strict selection that should be reserved to experienced institutions involved in the management of PC and gastric surgery.