RESUMO
The peritoneal metastasized colorectal cancer (pmCRC) represents a serious health problem worldwide with a special emphasis in the developed countries. Several guidelines recognize the role of multimodal therapy consisting of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of pmCRC. New data suggests that some other factors, eg, tumor biology, immune profile, neoadjuvant chemotherapy may play a predictive role for the oncological outcome of these patients.
RESUMO
BACKGROUND: The gold standard in the treatment of mucinous intra-abdominal neoplasms is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Despite complete cytoreduction up to 45% of patients develop recurrences. METHOD: A search and analysis of the current literature were carried out. RESULTS: There is still controversy regarding the best treatment strategy for patients with recurrent pseudomyxoma peritonei (PMP) after CRS and HIPEC. The clinical management of these patients depends on many factors, such as the site and volume of recurrence, histological subtype and symptoms. Treatment options range from repeated surgery with curative intent with or without HIPEC to watch and wait strategies. In selected patients redo surgery is feasible and safe with low morbidity and mortality. Iterative complete CRS can result in a median 5year overall survival of more than 80%. Debulking surgery leads to a prolonged survival and to symptom control fora period with of nearly 2 years. CONCLUSION: Repeated complete cytoreduction of recurrent PMP can result in long-term survival. Tumor debulking surgery may be particularly beneficial for symptomatic patients.
Assuntos
Neoplasias do Apêndice , Hipertermia Induzida , Neoplasias Císticas, Mucinosas e Serosas , Neoplasias Peritoneais , Pseudomixoma Peritoneal , Humanos , Pseudomixoma Peritoneal/cirurgia , Pseudomixoma Peritoneal/tratamento farmacológico , Neoplasias Peritoneais/cirurgia , Neoplasias Peritoneais/tratamento farmacológico , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/terapia , Neoplasias Císticas, Mucinosas e Serosas/terapiaRESUMO
BACKGROUND: The term pseudomyxoma peritonei (PMP) describes a clinical syndrome characterized by the presence of gelatinous intraperitoneal accumulation of mucus. It mostly originates from a mucocele of the vermiform appendix. Affected patients are often asymptomatic for a long time. Because of its indolent nature it is usually diagnosed at an advanced stage. Clinical presentation is determined by the dissemination of the tumor. METHOD: A search and analysis of the current literature were carried out. RESULTS: Based on the morphological characteristics PMP subtypes with various malignant potential can be differentiated. The prognosis depends on the histopathological differentiation and the clinical stage. The treatment spectrum varies from laparoscopic appendectomy to complete cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). CONCLUSION: Due to the rarity of PMP there are no prospective randomized studies. Therefore, there is still controversy regarding the best stage-dependent treatment strategy. This review article attempts to clarify the optimal management of mucinous neoplasms of the appendix and PMP taking the clinical presentation and the histological differentiation into consideration.
Assuntos
Hipertermia Induzida , Neoplasias Epiteliais e Glandulares , Neoplasias Peritoneais , Pseudomixoma Peritoneal , Humanos , Pseudomixoma Peritoneal/diagnóstico , Neoplasias Peritoneais/diagnóstico , Procedimentos Cirúrgicos de Citorredução , Neoplasias Epiteliais e Glandulares/terapiaRESUMO
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are recognized as the standard of care for selected patients with peritoneal malignancies. A complete macroscopic cytoreduction is the basis for a successful multimodal treatment. The significance of intraperitoneal chemotherapy is still under discussion. This review explains the principles and the value of HIPEC within the multimodal treatment context.
Assuntos
Hipertermia Induzida , Neoplasias Peritoneais , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia do Câncer por Perfusão Regional , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução , Humanos , Neoplasias Peritoneais/tratamento farmacológicoRESUMO
Peritoneal carcinomatosis remains a therapeutic challenge. The combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is currently the only potentially curative option with good results. For good oncological results a complete macroscopic cytoreduction is essential. This mostly requires a complex operative procedure with significant morbidity and mortality. Therefore, multimodal treatment is limited to a few highly selected patients. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a new minimally invasive approach, the value and spectrum of applications of which are still under investigation; however, the articles on PIPAC published so far are encouraging and PIPAC is therefore a possible palliative therapy option for patients who are not eligible for CRS and HIPEC. The aim of this review is to present a summary of the recent data regarding CRS-HIPEC and PIPAC.
Assuntos
Hipertermia Induzida , Neoplasias Peritoneais , Aerossóis , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução , Humanos , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapiaRESUMO
Cytoreductive surgery is an essential part of a multimodality treatment concept for peritoneal metastases. Indications are primary peritoneal tumors like peritoneal mesothelioma or secondaries from colorectal cancer or pseudomyxoma peritonei. Patients with gastric or ovarian carcinoma or abdominal sarcoma with peritoneal seedings can be treated within studies. Tumor entity, tumor load, and tumor distribution are the most critical issues for patient selection. Complete macroscopic cytoreduction is the strongest prognostic factor and can be achieved by parietal and visceral peritonectomy. The operation should be performed in a standardized manner. Due to possible tumor manifestation in all four quadrants of the abdomen and extensive extraperitoneal dissection, extensive surgical and oncological expertise is prerequisite. Treatment in specialized surgical oncology centers is recommended to minimize morbidity and mortality. The German Society for General and Visceral Surgery is certifying centers of competence for surgical treatment of peritoneal malignancies. Data of all patients are documented in the HIPEC register. The inclusion of patients in studies is recommended.