Oncologie

, Volume 16, Issue 11–12, pp 543–548 | Cite as

Chirurgie à visée curative des métastases péritonéales

  • D. Elias
  • D. Goéré
  • C. Honoré
  • D. Malka
  • V. Boige
  • P. Burtin
  • M. Ducreux
Mise au Point / Update
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Résumé

L’exérèse complète des métastases péritonéales (MP), suivie de chimiohyperthermie intrapéritonéale (CHIP, dont l’impact thérapeutique précis n’est pas encore connu), permet d’obtenir de nombreuses guérisons chez les patients éligibles. C’est devenu le standard thérapeutique lorsqu’elle est possible. Ces résultats en termes de survie sont strictement identiques à ceux des hépatectomies pour métastases hépatiques (MH). La survie des patients présentant des MP débutantes est particulièrement bonne, bien supérieure à celle de tout patient hépatectomisé pour MH. La principale avancée sera de savoir opérer tôt les patients présentant des MP débutantes ou ceux qui ont un haut risque de développer des MP. Le concept de second-look + CHIP découle tout logiquement de ce constat. À l’opposé, une exérèse incomplète des MP contre-indique la CHIP, de même qu’une extension péritonéale importante (même si elle est complètement résécable).

Mots clés

Métastases péritonéales Cancers colorectaux Chimiohyperthermie intrapéritonéale Chirurgie de réduction 

Curative surgery for peritoneal metastases

Abstract

The complete resection of the peritoneal metastases (PM), followed with HIPEC (hyperthermic intraperitoneal chemotherapy, whose precise therapeutic impact is not yet well-known), allows to obtain numerous cures in eligible patients. This is currently the gold-standard treatment when it is possible. Its survival results are strictly similar to those obtained with hepatectomy for liver metastases (LM). The survival rate of the patients with early PM is particularly high, far superior to those of any hepatectomized patient. The main progress will be to early-operate these patients, or to propose a prophylactic approach to those presenting a high-risk to develop PM. The concept of second-look surgery + HIPEC is the logical extension of this combined approach. In contrast, a non-complete cytoreductive surgery and a large peritoneal extension are contraindications to use this approach.

Keywords

Peritoneal metastases Colorectal cancer Cytoreductive surgery HIPEC 
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Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • D. Elias
    • 1
  • D. Goéré
    • 1
  • C. Honoré
    • 1
  • D. Malka
    • 1
  • V. Boige
    • 1
  • P. Burtin
    • 1
  • M. Ducreux
    • 1
  1. 1.Comité multidisciplinaire de cancérologie digestiveGustave-Roussy, Cancer Campus, Grand Pariscedex, VillejuifFrance

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