腹腔镜热灌注化疗联合腹腔及系统化疗转化治疗胃癌腹膜转移1例报告

Case analysis of conversion therapy by laparoscopic HIPEC combined with intraperitoneal and systemic chemotherapy for gastric cancer peritoneal metastasis

目的探讨腹腔镜腹腔热灌注化疗(HIPEC)联合腹腔及系统化疗模式用于胃癌腹膜转移转化治疗的有效性。方法北京大学肿瘤医院胃肠肿瘤中心于2016-12-11收治1例胃癌病人,腹腔镜探查提示腹膜转移,腹膜癌指数(PCI)高达39,腹腔镜下行多西他赛HIPEC 1次,后续紫杉醇(PTX)腹腔联合静脉化疗并同步口服替吉奥治疗6个周期。结果转化治疗后病人的CT检查及肿瘤标记物检测评价疗效良好,多学科综合治疗协作组(MDT)讨论后决定再行腹腔镜探查术。腹腔穿刺细胞学检查未见癌细胞,探查中未见明确腹膜转移病灶,行全胃切除+D2淋巴结清扫(除外No.10淋巴结)。术后病人恢复顺利。术后病理学检查示,胃体-窦中低分化腺癌,分期为yp T3N2M1。截至2017年9月,病人仍在术后治疗中。结论腹腔镜HIPEC联合腹腔及系统化疗模式用于胃癌腹膜转移转化治疗初步效果良好,值得进一步研究验证。

Objective To investigate the efficacy of laparoscopic hyperthermic intraperitoneal chemotherapy （HIPEC） combined intraperitoneal and systemic chemotherapy in gastric cancer patients with peritoneal metastasis. Methods A gastric cancer patient whose peritoneal cancer index was 39 during laparoscopic exploration was admitted at Peking University Cancer Hospital Gastrointestinal Center. The patient received laparoscopic HIPEC with docetaxel, followed by 6 courses of intraperitoneal and intravenous PTX, along with S-1 orally. Results CT scan showed distinct response during post-treatment evaluation. A second look by laparoscopy was suggested by MDT. No tumor cell was found in the lavage fluid through abdominocentesis and no metastasis can be seen by laparoscopic exploration. Then total gastrectomy plus D2 minus No.10 lymph node dissection was performed. The patient recovered smoothly after surgery. The pathology confirmed a ypT3N2MI, moderate to poor-differentiated adenocarcinoma, from gastric antrum to body. By September 2017, the patient was still in postoperative treatment. Conclusion Laparoscopic HIPEC combined with intraperitoneal and systemic chemotherapy showed effective interim resuIts in gastric cancer peritoneal metastasis conversion therapy and is deserved for further researches.