Recently, a novel comprehensive treatment consisting of cytoreductive surgery(CRS) and perioperative chemotherapy(POC) was developed for the treatment of peritoneal metastasis(PM) with a curative intent. In the treatm...Recently, a novel comprehensive treatment consisting of cytoreductive surgery(CRS) and perioperative chemotherapy(POC) was developed for the treatment of peritoneal metastasis(PM) with a curative intent. In the treatment, the macroscopic disease is completely removed by the peritonectomy techniques in combination with POC. This article reviews the results of the comprehensive treatment for PM from gastric cancer, and verifies the effects of CRS and POC, including neoadjuvant chemotherapy(NAC) and hyperthermic intraoperative intraperitoneal chemotherapy(HIPEC). Completeness of cytoreduction, peritoneal carcinomatosis index(PCI) less than the threshold levels after NAC,absence of ascites, cytologic status, pathologic response after NAC are the independent prognostic factors. Among these prognostic factors, PCI threshold level is the most valuable independent prognostic factor. After staging laparoscopy, patients with PM from gastric cancer are recommended to treat with NAC before CRS. After NAC, indication for CRS is determined by laparoscopy. The indications of the comprehensive treatment are patients with PCI less than the threshold levels, negative cytology, and responders after NAC. Patients satisfy these factors are the candidates for the CRS and HIPEC.展开更多
This review provides an overview of articles about peritoneal mesothelioma(PM)to analyze the effect of treatment modalities on response rates,post-treatment side effects,morbidity and mortality,and survival.Median sur...This review provides an overview of articles about peritoneal mesothelioma(PM)to analyze the effect of treatment modalities on response rates,post-treatment side effects,morbidity and mortality,and survival.Median survival in months following systemic chemotherapy(SC)ranged from 8.7 to 26.8 months.However,no patient was reported to have survived for more than five years with SC alone.In contrast,comprehensive treatment that included cytoreductive surgery(CRS)+perioperative chemotherapy(POC)showed a significantly longer median survival time than SC alone.Additionally,CRS+POC demonstrated 10-year survival rates of 12%-35%.Accordingly,CRS+POC is an innovative treatment that provides long-term survival in selected patients with PM.Selection criteria are performance status(ECOG PS≤1),the absence of extraperitoneal metastasis,PCI less than cutoff levels(from<10 to<28),MIB-1 index(<10),and histologic type(epithelioid type).Postoperative morbidity and mortality rates after CRS+POC were significantly higher than with more conventional operations.Accordingly,CRS and POC should be done at the specialized peritoneal surface malignancy centers.展开更多
文摘Recently, a novel comprehensive treatment consisting of cytoreductive surgery(CRS) and perioperative chemotherapy(POC) was developed for the treatment of peritoneal metastasis(PM) with a curative intent. In the treatment, the macroscopic disease is completely removed by the peritonectomy techniques in combination with POC. This article reviews the results of the comprehensive treatment for PM from gastric cancer, and verifies the effects of CRS and POC, including neoadjuvant chemotherapy(NAC) and hyperthermic intraoperative intraperitoneal chemotherapy(HIPEC). Completeness of cytoreduction, peritoneal carcinomatosis index(PCI) less than the threshold levels after NAC,absence of ascites, cytologic status, pathologic response after NAC are the independent prognostic factors. Among these prognostic factors, PCI threshold level is the most valuable independent prognostic factor. After staging laparoscopy, patients with PM from gastric cancer are recommended to treat with NAC before CRS. After NAC, indication for CRS is determined by laparoscopy. The indications of the comprehensive treatment are patients with PCI less than the threshold levels, negative cytology, and responders after NAC. Patients satisfy these factors are the candidates for the CRS and HIPEC.
文摘This review provides an overview of articles about peritoneal mesothelioma(PM)to analyze the effect of treatment modalities on response rates,post-treatment side effects,morbidity and mortality,and survival.Median survival in months following systemic chemotherapy(SC)ranged from 8.7 to 26.8 months.However,no patient was reported to have survived for more than five years with SC alone.In contrast,comprehensive treatment that included cytoreductive surgery(CRS)+perioperative chemotherapy(POC)showed a significantly longer median survival time than SC alone.Additionally,CRS+POC demonstrated 10-year survival rates of 12%-35%.Accordingly,CRS+POC is an innovative treatment that provides long-term survival in selected patients with PM.Selection criteria are performance status(ECOG PS≤1),the absence of extraperitoneal metastasis,PCI less than cutoff levels(from<10 to<28),MIB-1 index(<10),and histologic type(epithelioid type).Postoperative morbidity and mortality rates after CRS+POC were significantly higher than with more conventional operations.Accordingly,CRS and POC should be done at the specialized peritoneal surface malignancy centers.
