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Treatment Results of Peritonectomy Combined with Perioperative Chemotherapy for Colorectal Cancer-Patients with Peritoneal Carcinomatosis
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JPY
Abstract
Operation results of 81 colorecatal cancer-patients with peritoneal carcinomatosis (PC) treated with peritonectomy plusperioperative chemotherapy are reported. The patients who had the following evidences are considered to be eligible forperitonectomy: 1) No evidence of N3 lymph node involvement, 2) No evidence of hematogenous metastasis, 3) No progressivedisease after preoperative chemotherapy, 4) No severe co-morbidities or no poor general condition. Complete cytoreduction resection is aimed for removing all macroscopic tumors by peritonectomy using electrosurgicaltechniques. The completeness of cytoreduction( CC scores) after peritonectomy is classified into the following 4 criteria:CC-0-no peritoneal seeding was exposed during the complete exploration, CC-1-residual tumor nodules are less than2.5 mm in diameter, CC-2-nodules are between 2.5 mm and 25 mm in diameter, CC-3-nodules are greater than 25 mmin diameter, CC-2 and CC-3 are regarded as incomplete cytoreduction. Operation time and blood loss were 237±124 min. (799-90 min) and 1,598±1,411 mL (6,500-20 mL), respectively.Postoperative complications developed in 37(46%) patients. The patients received CC-0/-1 resection survived significantlylonger than those of CC-2/-3 group. The patients with PCI≦10 survived significantly longer than those with PCI≧11. CC and PCI scores are the independent prognostic factors. The relative risk for death of CC-2/-3 group was 4.6-foldhigher than that of CC-0/ -1 group. Accordingly, peritonectomy is indicated for patients with PCI score≦10. Key words:Colorectal cancer, Peritoneal carcinomatosis, Peritonectomy, Cytoreductive surgery, HIPEC
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