Comprehensive treatment for the peritoneal metastasis from gastric cancer  

作　　者：Yutaka Yonemura Emel Canbay Yoshio Endou Haruaki Ishibashi Akiyosi Mizumoto Yan Li Yang Liu Kazuyoshi Takeshita Masumi Ichinose Nobuyuki Takao Takuya Saitou Kousuke Noguchi Masamitu Hirano Oliver Glehen Bjorn Br?cher Paul H Sugarbaker 

机构地区：[1]NPO to Support Peritoneal Surface Malignancy Treatment [2]Department of Regional Cancer Therapies, Peritoneal Surface Malignancy Center, Kishiwada Tokusyukai Houspital, Kusatsu General Hospital [3]Department of Experimental Therapeutics, Cancer Research Institute, Kanazawa University [4]Department of Surgery, Wuhan University [5]Dēpartement de Chirurgie Gēnerale, Centre Hospitalier Lyon-Sud Hospices Civils de Lyon [6]Surgical Oncology,Department of Surgery, T?bingen Comprehensive Cancer center, University of T?bingen [7]Center of Gastrointestinal Malignancies, Program in Peritoneal Surface Malignancies, Med Star Washington Hospital Center

出　　处：《World Journal of Surgical Procedures》2015年第2期187-197,共11页世界外科手术杂志

摘　　要：Recently, a novel comprehensive treatment consisting of cytoreductive surgery(CRS) and perioperative chemotherapy(POC) was developed for the treatment of peritoneal metastasis(PM) with a curative intent. In the treatment, the macroscopic disease is completely removed by the peritonectomy techniques in combination with POC. This article reviews the results of the comprehensive treatment for PM from gastric cancer, and verifies the effects of CRS and POC, including neoadjuvant chemotherapy(NAC) and hyperthermic intraoperative intraperitoneal chemotherapy(HIPEC). Completeness of cytoreduction, peritoneal carcinomatosis index(PCI) less than the threshold levels after NAC,absence of ascites, cytologic status, pathologic response after NAC are the independent prognostic factors. Among these prognostic factors, PCI threshold level is the most valuable independent prognostic factor. After staging laparoscopy, patients with PM from gastric cancer are recommended to treat with NAC before CRS. After NAC, indication for CRS is determined by laparoscopy. The indications of the comprehensive treatment are patients with PCI less than the threshold levels, negative cytology, and responders after NAC. Patients satisfy these factors are the candidates for the CRS and HIPEC.Recently, a novel comprehensive treatment consisting of cytoreductive surgery(CRS) and perioperative chemotherapy(POC) was developed for the treatment of peritoneal metastasis(PM) with a curative intent. In the treatment, the macroscopic disease is completely removed by the peritonectomy techniques in combination with POC. This article reviews the results of the comprehensive treatment for PM from gastric cancer, and verifies the effects of CRS and POC, including neoadjuvant chemotherapy(NAC) and hyperthermic intraoperative intraperitoneal chemotherapy(HIPEC). Completeness of cytoreduction, peritoneal carcinomatosis index(PCI) less than the threshold levels after NAC,absence of ascites, cytologic status, pathologic response after NAC are the independent prognostic factors. Among these prognostic factors, PCI threshold level is the most valuable independent prognostic factor. After staging laparoscopy, patients with PM from gastric cancer are recommended to treat with NAC before CRS. After NAC, indication for CRS is determined by laparoscopy. The indications of the comprehensive treatment are patients with PCI less than the threshold levels, negative cytology, and responders after NAC. Patients satisfy these factors are the candidates for the CRS and HIPEC.

关 键 词：GASTRIC cancer Hyperthermic INTRAOPERATIVE INTRAPERITONEAL chemotherapy PERITONEAL metastasis PERITONECTOMY 

分 类 号：R[医药卫生]