AIM： To investigate the most important aspects of hyperthermic intraperitoneal chemotherapy （HIPEC） that has been accepted as the standard treatment for pseudomyxoma peritonei （PMP）, with special regard to morbid...AIM： To investigate the most important aspects of hyperthermic intraperitoneal chemotherapy （HIPEC） that has been accepted as the standard treatment for pseudomyxoma peritonei （PMP）, with special regard to morbidity, overall survival （OS） and disease free survival （DFS） over 10 years. METHODS： Fifty-three patients affected by PMP underwent cytoreduction （CCR） and HIPEC with a ＂semi-closed＂ abdomen technique in our institution. The peritonectomy procedure and completeness of CCR were classified according to Sugarbaker criteria. Preoperative evaluation always included thoracic and abdominal CT scan to stage peritoneal disease and exclude distant metastases. Fifty-one patients in our series were treated with a protocol based on administration of cisplatinum 100 mg/m^2 plus mitomycin C 16 mg/m^2, at a temperature of 41.5℃ for 60 min. Anastomoses were always performed at the end of HIPEC. The mean duration of surgery was 12 h including HIPEC. Continuous monitoring of hepatic and renal functions and hydroelectrolytic balance was performed in the postoperative period. RESULTS： Twenty-four patients presented with postoperative complications： surgical morbidity was observed in 16 patients and 6 patients were reoperated. All complications were successfully treated and no postoperative deaths were observed. Risk factors for postoperative morbidity were considered to be gender, age, body surface, duration of surgery,Peritoneal Cancer Index （PCI） and tumor residual value （CC score）. No statistically significant correlation was found during the multivariate analysis： only the CC score was statistically significant. The OS in our experience was 81.8%, with a DFS of 80% at 5 years and of 70% at 10 years. CONCLUSION： In our experience, even if HIPEC combined with cytoreductive surgery involves a high risk of morbidity, postoperative complications can be resolved favorably in most cases with correct patient selection and adequate postoperative care, thus minimizing mortality. The association of CCR and HIPEC can be considered as the standard treatment for PNP. The OS and DFS results confirm the validity of this combined approach for the treatment of this rare neoplasm. The impact of preoperative chemotherapy on OS, in our opinion, is due to a major aggressiveness of tumors in treated patients.展开更多
目的:探讨循环腹腔热灌注化疗(CHPPC)联合静脉化疗对老年胃癌患者术后肿瘤标志物含量及机体免疫功能的影响。方法:将104例胃癌患者按数字表法随机纳入对照组(行单纯静脉化疗)和研究组(行CHPPC联合静脉化疗)各52例,比较两组患者短期化疗...目的:探讨循环腹腔热灌注化疗(CHPPC)联合静脉化疗对老年胃癌患者术后肿瘤标志物含量及机体免疫功能的影响。方法:将104例胃癌患者按数字表法随机纳入对照组(行单纯静脉化疗)和研究组(行CHPPC联合静脉化疗)各52例,比较两组患者短期化疗效果、肿瘤标志物表达量、免疫功能、药物毒副作用、复发率及生存率的差异。结果:研究组与对照组短期治疗有效率(67.3%vs 28.8%)及肿瘤标志物CEA(3.42±2.44 vs 9.64±4.53)、CA199(15.44±4.35 vs 29.52±9.53)、CA242(4.31±2.52 vs 18.7±7.45)差异均具有统计学意义(P<0.05);且两组CD3^+、CD4^+、CD8^+及CD4^+/CD8^+值差异也有统计学意义(P<0.05);此外研究组复发率(19.2%)低于对照组(48.0%)(P<0.05)。结论:采用CHPPC联合静脉化疗治疗老年胃癌患者,有助于提高患者短期治疗效果,并降低患者肿瘤标志物表达水平,提高免疫功能。展开更多
文摘AIM： To investigate the most important aspects of hyperthermic intraperitoneal chemotherapy （HIPEC） that has been accepted as the standard treatment for pseudomyxoma peritonei （PMP）, with special regard to morbidity, overall survival （OS） and disease free survival （DFS） over 10 years. METHODS： Fifty-three patients affected by PMP underwent cytoreduction （CCR） and HIPEC with a ＂semi-closed＂ abdomen technique in our institution. The peritonectomy procedure and completeness of CCR were classified according to Sugarbaker criteria. Preoperative evaluation always included thoracic and abdominal CT scan to stage peritoneal disease and exclude distant metastases. Fifty-one patients in our series were treated with a protocol based on administration of cisplatinum 100 mg/m^2 plus mitomycin C 16 mg/m^2, at a temperature of 41.5℃ for 60 min. Anastomoses were always performed at the end of HIPEC. The mean duration of surgery was 12 h including HIPEC. Continuous monitoring of hepatic and renal functions and hydroelectrolytic balance was performed in the postoperative period. RESULTS： Twenty-four patients presented with postoperative complications： surgical morbidity was observed in 16 patients and 6 patients were reoperated. All complications were successfully treated and no postoperative deaths were observed. Risk factors for postoperative morbidity were considered to be gender, age, body surface, duration of surgery,Peritoneal Cancer Index （PCI） and tumor residual value （CC score）. No statistically significant correlation was found during the multivariate analysis： only the CC score was statistically significant. The OS in our experience was 81.8%, with a DFS of 80% at 5 years and of 70% at 10 years. CONCLUSION： In our experience, even if HIPEC combined with cytoreductive surgery involves a high risk of morbidity, postoperative complications can be resolved favorably in most cases with correct patient selection and adequate postoperative care, thus minimizing mortality. The association of CCR and HIPEC can be considered as the standard treatment for PNP. The OS and DFS results confirm the validity of this combined approach for the treatment of this rare neoplasm. The impact of preoperative chemotherapy on OS, in our opinion, is due to a major aggressiveness of tumors in treated patients.
文摘目的:探讨循环腹腔热灌注化疗(CHPPC)联合静脉化疗对老年胃癌患者术后肿瘤标志物含量及机体免疫功能的影响。方法:将104例胃癌患者按数字表法随机纳入对照组(行单纯静脉化疗)和研究组(行CHPPC联合静脉化疗)各52例,比较两组患者短期化疗效果、肿瘤标志物表达量、免疫功能、药物毒副作用、复发率及生存率的差异。结果:研究组与对照组短期治疗有效率(67.3%vs 28.8%)及肿瘤标志物CEA(3.42±2.44 vs 9.64±4.53)、CA199(15.44±4.35 vs 29.52±9.53)、CA242(4.31±2.52 vs 18.7±7.45)差异均具有统计学意义(P<0.05);且两组CD3^+、CD4^+、CD8^+及CD4^+/CD8^+值差异也有统计学意义(P<0.05);此外研究组复发率(19.2%)低于对照组(48.0%)(P<0.05)。结论:采用CHPPC联合静脉化疗治疗老年胃癌患者,有助于提高患者短期治疗效果,并降低患者肿瘤标志物表达水平,提高免疫功能。
