晚期上皮性卵巢癌腹膜播散模式及腹膜切除范围  

Peritoneal dissemination and extent of peritonectomy in advanced epithelial ovarian cancer

作　　者：Aditi Bhatt Snita Sinukumar Praveen Kammar Loma Parikh Gaurav Goswami Shweta Thakkar Sakina Shaikh Sanket Mehta 张新静(翻译) 李雁(审校) Aditi Bhatt;Snita Sinukumar;Praveen Kammar;Loma Parikh;Gaurav Goswami;Shweta Thakkar;Sakina Shaikh;Sanket Mehta(Department of Surgical Oncology,Zydus Hospital,Ahmedabad,India;Department of Surgical Oncology,Jehangir Hospital,Pune,In-dia;Department of Surgical Oncology,Mumbai,India;Department of Pathology,Zydus Hospital,India;Department of Radiology,Zy-dus Hospital,India)

机构地区：[1]印度艾哈迈达巴德Zydus医院肿瘤外科 [2]印度普那Jehangir医院肿瘤外科 [3]印度孟买医院肿瘤外科 [4]印度艾哈迈达巴德Zydus医院病理科 [5]印度艾哈迈达巴德Zydus医院放射科 [6]不详

出　　处：《中国肿瘤临床》2022年第24期1291-1294,共4页Chinese Journal of Clinical Oncology

摘　　要：根据晚期上皮性卵巢癌(epithelial ovarian cancer,EOC)患者腹膜播散模式和腹膜切除范围的最新研究进展,分析评估肿瘤细胞减灭术(cytoreductive surgery,CRS)中行全壁腹膜切除术(total parietal peritonectomy,TPP)和内脏腹膜广泛切除术的前瞻性研究初步结果。在手术期间看似“正常”的腹膜中,隐匿性疾病的发生率较高,这可能是疾病复发的来源。腹腔热灌注化疗(hyperthermic intraperitoneal chemotherapy,HIPEC)主要作用于微小病灶和手术过程中脱落到腹腔内的游离癌细胞,从而降低复发风险;与单纯CRS相比,HIPEC联合CRS在无进展生存率和总生存率上均显示出优势。彻底根除这种隐匿性疾病的唯一方法为腹膜切除,TPP与内脏腹膜广泛切除术可能是治疗这种隐匿性疾病最有效的策略。TPP的术后并发症可接受,TPP可延长无进展生存率和总生存率,且TPP后铂类耐药复发的发生率远低于既往结果。We reviewed the current literature regarding patterns of peritoneal dissemination and extent of peritoneal resection that should be performed in patients with advanced epithelial ovarian cancer(EOC). The preliminary results of our prospective study evaluating the role of total parietal peritonectomy(TPP) and wide resection of the visceral peritoneum performed during interval cytoreductive surgery(CRS) are presented and discussed. Studies on peritoneal spread and response to systemic chemotherapy in EOC show that the incidence of occult disease is high in the peritoneum that appears ‘normal’ during surgery and is likely to be the source of recurrent disease. Hyperthermic intraperitoneal chemotherapy(HIPEC) acts on microscopic disease as well as free intraperitoneal cancer cells shed during surgery, thus, reducing the risk of recurrence. The addition of HIPEC to interval CRS showed a benefit in both progression-free and overall survival over interval CRS alone. The only definitive way to eradicate such occult disease completely is resection of the peritoneum. And thus, a TPP performed along with wide resection of the visceral peritoneum may be a more effective strategy for addressing this occult disease compared to other locoregional therapies like HIPEC and systemic therapies. The postoperative complications was acceptable. Both progression-free and overall survival are improved after TPP. The incidence of platinum resistance recurrence was much lower than previous reports.

关 键 词：上皮性卵巢癌 腹膜播散模式 腹膜切除范围 肿瘤细胞减灭术 全壁腹膜切除 

分 类 号：R737.31[医药卫生—肿瘤]