Skip to main content
SpringerLink
Log in

Peritonealkarzinose

Chirurgische Behandlungsmöglichkeiten einschließlich hyperthermer intraperitonealer Chemotherapie

Peritoneal carcinomatosis

Surgical treatment, including hyperthermal intraperitoneal chemotherapy

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Das kolorektale Karzinom ist die zweithäufigste maligne Erkrankung und für einen nicht unerheblichen Teil aller Krebstodesfälle verantwortlich. Über 10% der betroffenen Patienten zeigen bereits bei Diagnosestellung eine peritoneale Metastasierung. Hinzu kommen weitere Patienten mit Peritonealkarzinose im Rahmen eines Tumorrezidivs. Für einen hoch selektionierten Teil dieser Patienten steht mit der zytoreduktiven Chirurgie und hyperthermen intraperitonealen Chemotherapie ein neues Therapieregime zur Verfügung, durch dessen Einsatz sich das Überleben dieser Patienten signifikant verbessern lässt. Trotz des aggressiven Vorgehens sind die Eingriffe in spezialisierten Zentren insbesondere nach Abschluss der Lernkurve mit einer vertretbaren Morbidität und niedriger Letalität durchführbar. Entscheidend für den Therapieerfolg sind eine konsequente präoperative Diagnostik zur Selektion geeigneter Patienten sowie die Einbindung des Therapieregimes in ein interdisziplinäres Behandlungskonzept. In der vorliegenden Arbeit wird das Therapieregime vorgestellt und das Patientenoutcome anhand publizierter Studien und eigener Daten aufgezeigt.

Abstract

Colorectal cancer is a common malignant disease with increasing incidence and a significant cause of death in cancer patients. More than 10% of patients with colorectal cancer show peritoneal carcinomatosis at initial diagnosis. Moreover, peritoneal metastasis is a common sign of recurrence. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a new treatment strategy for highly selected patients with peritoneal carcinomatosis. Numerous studies show prolonged survival after CRS and HIPEC with acceptable morbidity and mortality rates. Accurate preoperative diagnostics and patient selection play a pivotal role in postoperative patient outcome. This promising treatment strategy is discussed regarding surgical technique, intraperitoneal chemotherapy, and patient outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Bijelic L, Yan TD, Sugarbaker PH (2007) Failure analysis of recurrent disease following complete cytoreduction and perioperative intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. Ann Surg Oncol 14: 2281–2288

    Article  PubMed  Google Scholar 

  2. Culliford AT, Brooks AD, Sharma S et al. (2001) Surgical debulking and intraperitoneal chemotherapy for established peritoneal metastases from colon and appendix cancer. Ann Surg Oncol 8: 787–795

    Article  PubMed  Google Scholar 

  3. Elias D, Delperro JR, Sideris L et al. (2004) Treatment of peritoneal carcinomatosis from colorectal cancer: impact of complete cytoreductive surgery and difficulties in conducting randomized trials. Ann Surg Oncol 11: 518–521

    Article  PubMed  Google Scholar 

  4. Elias D, Raynard B, Farkhondeh F et al. (2006) Peritoneal carcinomatosis of colorectal origin. Gastroenterol Clin Biol 30: 1200–1204

    PubMed  CAS  Google Scholar 

  5. Elias D, Benizri E, Di Pietrantonio D et al. (2007) Comparison of two kinds of intraperitoneal chemotherapy following complete cytoreductive surgery of colorectal peritoneal carcinomatosis. Ann Surg Oncol 14: 509–514

    Article  PubMed  Google Scholar 

  6. Elias D, Goere D, Blot F et al. (2007) Optimization of hyperthermic intraperitoneal chemotherapy with oxaliplatin plus irinotecan at 43 degrees C after complete cytoreductive surgery: mortality and morbidity in 106 consecutive patients. Ann Surg Oncol 14: 1818–1824

    Article  PubMed  Google Scholar 

  7. Esquivel J, Vidal-Jove J, Steves MA, Sugarbaker PH (1993) Morbidity and mortality of cytoreductive surgery and intraperitoneal chemotherapy. Surgery 113: 631–636

    PubMed  CAS  Google Scholar 

  8. Esquivel J, Sticca R, Sugarbaker P et al. (2007) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 14: 128–133

    Article  PubMed  CAS  Google Scholar 

  9. Garofalo A, Valle M (2003) [Staging videolaparoscopy of peritoneal carcinomatosis]. Tumori 89: 70–77

    PubMed  CAS  Google Scholar 

  10. Glehen O, Osinsky D, Cotte E et al. (2003) Intraperitoneal chemohyperthermia using a closed abdominal procedure and cytoreductive surgery for the treatment of peritoneal carcinomatosis: morbidity and mortality analysis of 216 consecutive procedures. Ann Surg Oncol 10: 863–869

    Article  PubMed  CAS  Google Scholar 

  11. Glehen O, Cotte E, Schreiber V et al. (2004) Intraperitoneal chemohyperthermia and attempted cytoreductive surgery in patients with peritoneal carcinomatosis of colorectal origin. Br J Surg 91: 747–754

    Article  PubMed  CAS  Google Scholar 

  12. Glehen O, Kwiatkowski F, Sugarbaker PH et al. (2004) Cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis from colorectal cancer: a multi-institutional study. J Clin Oncol 22: 3284–3292

    Article  PubMed  CAS  Google Scholar 

  13. Jacquet P, Stephens AD, Averbach AM et al. (1996) Analysis of morbidity and mortality in 60 patients with peritoneal carcinomatosis treated by cytoreductive surgery and heated intraoperative intraperitoneal chemotherapy. Cancer 77: 2622–2629

    Article  PubMed  CAS  Google Scholar 

  14. Kecmanovic DM, Pavlov MJ, Ceranic MS et al. (2005) Treatment of peritoneal carcinomatosis from colorectal cancer by cytoreductive surgery and hyperthermic perioperative intraperitoneal chemotherapy. Eur J Surg Oncol 31: 147–152

    Article  PubMed  CAS  Google Scholar 

  15. Levi F, Zidani R, Brienza S et al. (1999) A multicenter evaluation of intensified, ambulatory, chronomodulated chemotherapy with oxaliplatin, 5-fluorouracil, and leucovorin as initial treatment of patients with metastatic colorectal carcinoma. International Organization for Cancer Chronotherapy. Cancer 85: 2532–2540

    Article  PubMed  CAS  Google Scholar 

  16. Mahteme H, Hansson J, Berglund A et al. (2004) Improved survival in patients with peritoneal metastases from colorectal cancer: a preliminary study. Br J Cancer 90: 403–407

    Article  PubMed  CAS  Google Scholar 

  17. Moran BJ, Mukherjee A, Sexton R (2006) Operability and early outcome in 100 consecutive laparotomies for peritoneal malignancy. Br J Surg 93: 100–104

    Article  PubMed  CAS  Google Scholar 

  18. Pestieau SR, Sugarbaker PH (2000) Treatment of primary colon cancer with peritoneal carcinomatosis: comparison of concomitant vs. delayed management. Dis Colon Rectum 43: 1341–1346; discussion 1347–1348

    Article  PubMed  CAS  Google Scholar 

  19. Pilati P, Mocellin S, Rossi CR et al. (2003) Cytoreductive surgery combined with hyperthermic intraperitoneal intraoperative chemotherapy for peritoneal carcinomatosis arising from colon adenocarcinoma. Ann Surg Oncol 10: 508–513

    Article  PubMed  Google Scholar 

  20. Rougier P, Van Cutsem E, Bajetta E et al. (1998) Randomised trial of irinotecan versus fluorouracil by continuous infusion after fluorouracil failure in patients with metastatic colorectal cancer. Lancet 352: 1407–1412

    Article  PubMed  CAS  Google Scholar 

  21. Russell AH, Tong D, Dawson LE, Wisbeck W (1984) Adenocarcinoma of the proximal colon. Sites of initial dissemination and patterns of recurrence following surgery alone. Cancer 53: 360–367

    Article  PubMed  CAS  Google Scholar 

  22. Sadeghi B, Arvieux C, Glehen O et al. (2000) Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer 88: 358–363

    Article  PubMed  CAS  Google Scholar 

  23. Shen P, Hawksworth J, Lovato J et al. (2004) Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy with mitomycin C for peritoneal carcinomatosis from nonappendiceal colorectal carcinoma. Ann Surg Oncol 11: 178–186

    Article  PubMed  Google Scholar 

  24. Smeenk RM, Verwaal VJ, Zoetmulder FA (2007) Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg: Epub ahead of print

    Google Scholar 

  25. Stephens AD, Alderman R, Chang D et al. (1999) Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann Surg Oncol 6: 790–796

    Article  PubMed  CAS  Google Scholar 

  26. Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221: 29–42

    PubMed  CAS  Google Scholar 

  27. Sugarbaker PH, Jablonski KA (1995) Prognostic features of 51 colorectal and 130 appendiceal cancer patients with peritoneal carcinomatosis treated by cytoreductive surgery and intraperitoneal chemotherapy. Ann Surg 221: 124–132

    Article  PubMed  CAS  Google Scholar 

  28. Verwaal VJ, Ruth S van, Bree E de et al. (2003) Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer. J Clin Oncol 21: 3737–3743

    Article  PubMed  Google Scholar 

  29. Verwaal VJ, Tinteren H van, Ruth SV, Zoetmulder FA (2004) Toxicity of cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy. J Surg Oncol 85: 61–67

    Article  PubMed  Google Scholar 

  30. Yan TD, Links M, Fransi S et al. (2007) Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy-a journey to becoming a nationally funded peritonectomy center. Ann Surg Oncol 14: 2270–2280

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Chirurgie, Universitätsklinikum, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Deutschland

    G. Glockzin, N. Ghali, S.A. Lang, A. Agha, H.J. Schlitt &  P. Piso

Authors
  1. G. Glockzin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Ghali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S.A. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Agha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H.J. Schlitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Piso
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Piso.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Glockzin, G., Ghali, N., Lang, S. et al. Peritonealkarzinose. Chirurg 78, 1100–1110 (2007). https://doi.org/10.1007/s00104-007-1419-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-007-1419-0

Schlüsselwörter

Keywords

Search

Navigation