Results of Systematic Second-Look Surgery in Patients at High Risk of Developing Colorectal Peritoneal Carcinomatosis

Élias, Dominique; Goèré, Diane; Pietrantonio, Daniela Di; Boige, Valérie; Malka, David; Kohneh-Shahri, N.; Dromain, Clarisse; Ducreux, Michel

doi:10.1097/sla.0b013e31815f0113

Cited by 136 publications

(109 citation statements)

References 22 publications

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“…Pacientams, kuriems pakartotinės pilvo ertmės apžiūros metu nustatomas ligos recidyvas, turi būti atliekamas CRS (šalinama pažeista pilvaplėvė bei vidaus organai) ir HIPEC. Elias ir bendraautorių prospektyvioje studijoje teigiama, jog veiksniai, didinantys karcinomatozės riziką, yra perforavęs navikas (recidyvas nuo 14 % iki 58 % atvejų), metastazės kiaušidėse (recidyvas nuo 27 % iki 56 %), lokali karcinomatozė (recidyvas nuo 64 % iki 91 %) [9]. Honore ir bendraautoriai tyrime nustatyti rizikos veiksniai buvo labai panašūs: peritoninė karcinomatozė, metastazės kiaušidėse, perforavęs navikas, naviko invazija į gretimus organus [10].…”

Section: Išgyvenamumas Vėžiui Nerecidyvavusunclassified

Recidyvo rizikos veiksniai po radikalios kolorektalinio vėžio operacijos

Mikėnas¹,

Liaudginas²,

Paškonis³

et al. 2017

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ĮvadasLietuvoje kasmet diagnozuojama apie 1500 kolorektalinio vėžio atvejų ir sergamumas šia liga kiekvienais metais didėja. Radi kalus chirurginis gydymo būdas taikomas siekiant pašalinti vėžį ir taip pailginti pacientų išgyvenamumą. Po operacijos profi laktinių patikrų metu suvėžėjusias pilvaplėvės ląsteles yra sunku diagnozuoti dėl klinikinių simptomų stokos ir nepakankamo vaizdinių tyrimų jautrumo. Todėl pacientams, turintiems rizikos veiksnius recidyvui atsirasti, tikslinga taikyti diagnostinę rela parotomiją, kurios metu būtų atliekama HIPEC procedūra. Ligoniai ir metodaiAtliktas retrospektyvusis tyrimas VULSK Pilvo chirurgijos centre. Tirti 321 pacientai, kuriems 2011-2014 m. diagnozuotas kolo rektalinis T3-T4 stadijos neišplitęs navikas ir taikytas radikalus chirurginis gydymas. Į tyrimą įtraukti 208 pacientai. Analizuoti operacijų protokolai bei histologiniai navikų aprašai. Rezultatai Analizuoti 208 pacientų duomenys. 34 (16,3 %) pacientams buvo nustatyti pirminio naviko recidyvai. Recidyvavo 15 (26,8 %) T4 histologinio tipo navikų ir 19 (12,5 %) T3 navikų (p=0,013). Recidyvavimas pagal išplitimą į regioninius limfmazgius buvo 10 (9,8 %) N0, 12 (18,2 %) N1 ir 12 (30 %) N2 grupėse (p=0,012). Iš žarnos spindį užkimšusių navikų recidyvavo 7 (46,7%) (p=0,003). Statistiškai reikšmingo ryšio tarp recidyvų dažnio ir pirminio naviko lokalizacijos, histologinio tipo ir pirminio navi ko perforacijos nenustatėme. Penkerių metų išgyvenamumas nenustačius ligos recidyvo buvo 24,65 %, o recidyvavus -0 %. Išvados Atlikus radikalią kolorektalinio naviko šalinimo operaciją, svarbu šiuos pacientus stebėtis dėl galimo ligos recidyvavimo. Paci entams, turintiems didelę riziką recidyvui atsirasti, yra tikslinga svarstyti relaparotomijos su CRS ir HIPEC galimybę. Reikšminiai žodžiai: kolorektalinis vėžys, recidyvas, rizikos veiksniai 45Recidyvo rizikos veiksniai po radikalios kolorektalinio vėžio operacijos Introduction Each year about 1,500 cases of colorectal cancer is diagnosed in Lithuania and the incidence of this disease is increasing every year. Radical surgery removal is the first choice treatment of the cancer that presents the best longterm results. Recurrence of the disease after surgery is difficult to diagnose due to the lack of clinical symptoms and insufficient sensitivity of imag ing study. The aim of the study was to evaluate risk factors for secondlook surgery of colorectal cancer following complete cytoreductive surgery. Materials and methodsBetween 2011 and 2014 in 321 cases radical T3T4 stage colorectal cancer surgery was performed. 208 of 321 patients were involved to study. In a single centre retrospective study we analyzed operation records and pathophysiological protocols. Results A total 34 (16.3%) patients had recurrence of the disease in 14 year. In 15 (26,8%) T4 stage and 19 (12.5%) T3 stage cases colorectal cancer relapsed (p=0,013). Lymph node invasion impacts recurrence: N0 -10 (9.8%), N1 -12 (18.2%) N1, N2 -12 (30%) (p=0.012). 7 (46.7%) occlusive colorectal cancer cases had recurrence (p=0.00...

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Section: Išgyvenamumas Vėžiui Nerecidyvavusunclassified

Recidyvo rizikos veiksniai po radikalios kolorektalinio vėžio operacijos

Mikėnas¹,

Liaudginas²,

Paškonis³

et al. 2017

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“…A report of similar strategy for these patients with PM at primary colorectal cancer resection was presented by Elias and colleagues from Villejuif, France [15]. This was a highly selected group of patients who had biopsy-proven PM, ovarian PM, or perforation confirmed at the time of primary colorectal cancer resection.…”

Section: Requirement For Referral To An Experienced Treatment Centermentioning

confidence: 99%

Management Of Unexpected Peritoneal Metastases With Primary Colorectal Cancer Using Second-Look Surgery With HIPEC

Sugarbaker¹,

Gléhen²

2017

Cancer Surg

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Background: Peritoneal metastases (PM) will be unexpectedly present in approximately 10% of colorectal cancer patients having primary cancer resection. In the past this was considered to be an incurable condition with a terminal outcome. In patients determined to have peritoneal dissemination at the time of resection, the intervention was considered palliative. Recently, long term benefit from definitive treatment of PM with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has become a reality. These treatments are now appropriate for primary appendiceal and colorectal cancer determined to have PM at the time of resection.

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“…In Elias et al's systematic second-look surgery in patients at high risk of developing colorectal peritoneal carcinomatosis, more than 50% of these patients were found to have peritoneal disease that was not detected by clinical and imaging modalities [6]. The high risk features included peritoneal nodules detected at time of primary cancer resection, presence of ovarian metastases at primary surgery, primary cancer perforation or obstruction, adjacent organ or structure invasion and fistula formation.…”

Section: How To Treat a Disease That Cannot Be Detected?mentioning

confidence: 99%

Cytoreductive Surgery and HIPEC for Colorectal Cancer: Facing the Facts and Addressing the Issues to Allow for Widespread Acceptance

Ching¹,

Ching²

2015

Arch Can Res

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Abstract60% of colorectal cancers are diagnosed at an advanced stage. Curative strategies involving multimodality treatment with surgical resection and chemotherapy have been employed for liver and lung metastases from colorectal cancer.Peritoneal metastases are diagnosed synchronously in 10-15% of all newly diagnosed colorectal cancer, and in 40-70% of patients who suffer a recurrence. They are the sole sites of metastases in 10-30% of these cases. An understanding of peritoneal metastases must take into consideration the following:1. Peritoneal metastases do not respond to systemic chemotherapy in the same fashion as liver and lung metastases 2. Peritoneal disease causes many local problems, resulting in disruption of planned chemotherapy 3. CRS and HIPEC actually works for peritoneal disease and 4. Peritoneal disease is usually not detected on state-of-the-art imaging modalities.Despite mounting evidence of the effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) at prolonging survival in selected patients with colorectal peritoneal carcinomatosis, there remains a reluctance to explore this combined treatment modality. This is likely to be a result of the perceived morbidity and mortality of such a procedure, with most medical oncologists and colorectal surgeons being unfamiliar with the combined treatment. As with all complex procedures, a learning curve is observed, with proficiency likely only after 25 cases and at a high volume centre, with more than 30 cases annually.An effective management strategy employing CRS and HIPEC for selected patients with colorectal peritoneal carcinomatosis can only be achieved if a concerted effort is made to understand this disease and address the concerns regarding this treatment.

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Results of Systematic Second-Look Surgery in Patients at High Risk of Developing Colorectal Peritoneal Carcinomatosis

Abstract: Performing second-look surgery at 1 year in selected patients at high risk of developing PC allowed the early detection and treatment of PC in 55% of cases. Our preliminary results have encouraged us to pursue this strategy and to evaluate it in a prospective multicenter trial.

Cited by 136 publications

References 22 publications

Recidyvo rizikos veiksniai po radikalios kolorektalinio vėžio operacijos

Recidyvo rizikos veiksniai po radikalios kolorektalinio vėžio operacijos

Management Of Unexpected Peritoneal Metastases With Primary Colorectal Cancer Using Second-Look Surgery With HIPEC

Cytoreductive Surgery and HIPEC for Colorectal Cancer: Facing the Facts and Addressing the Issues to Allow for Widespread Acceptance

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