中国癌症杂志 ›› 2015, Vol. 25 ›› Issue (11): 890-894.doi: 10.3969/j.issn.1007-3969.2015.11.008

• 特约专家述评及综述 • 上一篇    下一篇

结直肠癌腹膜转移的多学科综合治疗

蔡国响,孟献珂,蔡三军   

  1. 复旦大学附属肿瘤医院大肠外科,复旦大学上海医学院肿瘤学系,上海200032
  • 出版日期:2015-11-30 发布日期:2016-02-01
  • 通信作者: 蔡三军 E-mail:caisanjun@tom.com

Multidisciplinary treatment of colorectal cancer peritoneal metastasis

CAI Guoxiang, MENG Xianke, CAI Sanjun   

  1. Department of Colorectal Cancer Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
  • Published:2015-11-30 Online:2016-02-01
  • Contact: CAI Sanjun E-mail: caisanjun@tom.com

摘要: 腹膜转移是结直肠癌常见转移部位之一,传统观念认为其预后差,没有手术治疗的价值。近年来,随着外科技术、精确控温的腹腔热灌注化疗以及多学科综合治疗的进步,对结直肠癌腹膜转移的认识和治疗策略发生很大的变化,拟就这一问题进行综述。在预后方面,如果仅行姑息性化疗,结直肠癌腹膜转移的预后差于肝、肺等非腹膜部位的转移;但对于一部分合适的患者施行完全性腹膜减瘤术联合腹腔热灌注化疗,则可能使部分患者获得长期生存;腹膜转移癌的预后因素包括腹膜播散癌指数、减瘤术完全性程度、是否合并腹膜外转移(肝脏等)、腹膜表面疾病严重程度评分和日本腹膜分期等。在治疗方面,完全性腹膜减瘤术联合腹腔热灌注化疗以及全身治疗(化疗+靶向治疗),可能是最佳的多学科综合治疗策略。

关键词: 结直肠癌, 腹膜转移, 减瘤术, 腹腔热灌注化疗, 多学科综合治疗

Abstract: Peritoneum is one of the common site of colorectal cancer metastasis. Traditionally, peritoneal carcinomatosis is associated with a poor prognosis without effective surgical treatment. Recently, the attitude towards the treatment strategies for colorectal peritoneal metastasis has changed significantly with advances in surgical techniques, hyperthermic intraperitoneal chemotherapy and multi-disciplinary treatment. As to the prognosis, colorectal peritoneal metastasis has an inferior outcome to non-peritoneal metastasis under the palliative systemic treatment. However, the complete peritoneal cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy can achieve a long-term survival in selective patients with colorectal peritoneal metastasas. The prognostic factors include peritoneal carcinomatosis index, completeness of cytoreduction, the presence of extra-peritoneal metastasis (liver etc), peritoneal surface disease severity score and Japanese peritoneal staging. In terms of the treatment, complete peritoneal cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy and systemic treatment (including chemotherapy and targeted therapy) may be the best modality of multi-disciplinary treatment for colorectal peritoneal metastasis.

Key words: Colorectal cancer, Peritoneal metastasis, Cytoreduction surgery, Hyperthermic intraperitoneal chemotherapy, Multi-disciplinary treatment