RESUMO
BACKGROUND: Cytoreductive surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the optimal treatment for Pseudomyxoma Peritonei (PMP). Despite treatment, disease often recurs and may not be amenable to further CRS. Clinical experience suggests a spectrum of disease which may correlate with tumour marker levels. The aim of this study was to analyse the influence of markers on recurrence and survival. METHODS: The details of all patients undergoing surgery for PMP of appendiceal origin at a national centre for peritoneal malignancy were recorded in a dedicated prospective database. The data on all patients who had CRS and HIPEC between March 1994 and January 2012 was analysed and recurrence and survival correlated with pre-operative levels of CEA, CA-125 and CA19-9. RESULTS: Overall, 519 (69%) of 752 consecutive patients, underwent complete CRS and HIPEC. The median (range) age was 56 (20-82) years with 342/519 (66%) females. The mean overall (OS) and disease free survival (DFS) in the 131/519 patients who had normal preoperative tumour markers was 168 (128-207) and 125 (114-136) months respectively, significantly higher when compared with the 109/519 (21%) who had all three tumour markers elevated (OS of 65 (42-88) and DFS of 55 (41-70) months respectively) (P = 0.002). CONCLUSIONS: Elevated tumour markers predict an increased risk of recurrence and reduced survival after complete CRS. This may reflect cell biology in low grade tumours and is an independent prognostic feature. Further analysis may help to select patients for post-operative chemotherapy, second look procedures or stratification of follow up.
Assuntos
Neoplasias do Apêndice/metabolismo , Biomarcadores Tumorais/metabolismo , Antígeno Ca-125/metabolismo , Antígeno CA-19-9/metabolismo , Antígeno Carcinoembrionário/metabolismo , Recidiva Local de Neoplasia/metabolismo , Neoplasias Peritoneais/metabolismo , Pseudomixoma Peritoneal/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/terapia , Feminino , Humanos , Hipertermia Induzida , Infusões Parenterais , Masculino , Pessoa de Meia-Idade , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Peritônio/patologia , Peritônio/cirurgia , Prognóstico , Pseudomixoma Peritoneal/mortalidade , Pseudomixoma Peritoneal/terapia , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
AIM: Optimal colon cancer surgery correlates with a reduction in recurrence rate and improved overall prognosis. This technical note describes the extraperitoneal approach for locally advanced right colon cancer. METHOD: The retroperitoneal technique, mainly used in pseudomyxoma peritonei resectional surgery, is described in three surgical steps and it is compared with existing surgical approaches for right colon cancer. RESULTS: This approach has the advantages of early entry in the retroperitoneal plane well away from the tumour, early recognition and protection of the ureter and minimal manipulation of the tumour-bearing right colon. CONCLUSION: Extraperitoneal resection of the right colon for locally advanced colon cancer is technically feasible, safe and achieves tumour-free retroperitoneal margins.