胃癌腹膜转移综合治疗日本实践

Japanese practice of comprehensive treatment for peritoneal metastasis of gastric cancer

胃癌腹膜转移患者预后极差,单纯手术治疗和系统化疗的疗效甚微。一种联合肿瘤细胞减灭术和腹腔内热灌注化疗的综合治疗方式被用于治疗胃癌腹膜转移患者。21世纪初期开始,岸和田德州会病院腹膜种植中心一直致力于发展和改进针对胃癌腹膜转移的综合治疗。合适的胃癌腹膜转移癌患者接受腹腔镜下腹腔内热灌注化疗、腹腔内化疗、静脉化疗和口服化疗等新辅助化疗。然后进行肿瘤细胞减灭术联合腹腔内热灌注化疗,尽量达到完全肿瘤细胞减灭。手术治疗后进行术后腹腔内化疗和系统化疗等综合辅助治疗。对于胃癌腹膜转移患者实施合适的综合治疗(包括新辅助化疗、肿瘤细胞减灭术联合腹腔内热灌注化疗)能明显改善胃癌腹膜转移患者的预后和总体生存。

Patients with peritoneal metastasis(PM)from gastric cancer(GC)have a poor prognosis.Surgery or systemic treatment alone hardly improves the prognosis and overall survival(OS).A newly developed comprehensive treatment involving a combination of cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)has been used to treat patients with PM from GC.The Peritoneal Dissemination Center of Kishiwada Tokushukai Hospital in Japan has been committed to treating patients with PM from GC.Selected patients undergo laparoscopic hyperthermic intraperitoneal chemotherapy(LHIPEC),preoperative intraperitoneal(IP)chemotherapy,and systemic chemotherapy that includes intravenous and oral chemotherapy prior to surgery.CRS plus HIPEC is then performed to achieve complete cytoreduction.Postoperative IP chemotherapy or systemic chemotherapy is also administered to nearly all patients.The results demonstrate that comprehensive treatment,including neoadjuvant chemotherapy and CRS plus HIPEC,can significantly improve the prognosis and OS of selected patients with PM from GC.