PDF(Pubmed)
Abstract：
BACKGROUND: Patients with colon cancer may present at multiple different stages of the disease process. Many patients can be cured of colon cancer as a result of a simple surgical procedure usually performed by minimally invasive techniques. However, there are a variable number of patients, estimated at approximately 10%, who have a more advanced disease. If these patients are treated by the current conventional standard of care, the likelihood for treatment failure is extremely high.
METHODS: These are not patients with known disseminated disease but patients who are at high risk of recurrent disease unless special treatments are initiated preoperatively and intraoperatively. The identification of these patients is by (1) a high-quality CT scan, (2) tumor markers found preoperatively, (3) colonoscopic findings, and (4) symptoms.
RESULTS: Patients identified as being at high risk require special preoperative treatments which include neoadjuvant chemotherapy. Intraoperative chemotherapy with HIPEC should occur as part of the treatment if peritoneal metastases are documented by biopsy. In the operating room, a thorough exploration of all possible occult peritoneal spaces for metastatic disease needs to be performed. A modified cytoreductive surgical procedure along with a colon resection is performed in order to minimize sites of occult peritoneal metastases. This includes the greater omentum, ovaries, and tubes in postmenopausal women. Peritonectomy is used to create a shroud around the tumor so that all peritoneum that has been in direct contact with the tumor surface is resected and is used as a barrier against tumor cell dissemination in the process of colon cancer resection. If peritoneal metastases are visualized at any site, HIPEC should be included as part of the treatment package.
CONCLUSIONS: I am convinced that patients at high risk of recurrence will have an improved outcome with proper preoperative evaluation, preoperative neoadjuvant chemotherapy, and a revised intraoperative management strategy.
METHODS: These are not patients with known disseminated disease but patients who are at high risk of recurrent disease unless special treatments are initiated preoperatively and intraoperatively. The identification of these patients is by (1) a high-quality CT scan, (2) tumor markers found preoperatively, (3) colonoscopic findings, and (4) symptoms.
RESULTS: Patients identified as being at high risk require special preoperative treatments which include neoadjuvant chemotherapy. Intraoperative chemotherapy with HIPEC should occur as part of the treatment if peritoneal metastases are documented by biopsy. In the operating room, a thorough exploration of all possible occult peritoneal spaces for metastatic disease needs to be performed. A modified cytoreductive surgical procedure along with a colon resection is performed in order to minimize sites of occult peritoneal metastases. This includes the greater omentum, ovaries, and tubes in postmenopausal women. Peritonectomy is used to create a shroud around the tumor so that all peritoneum that has been in direct contact with the tumor surface is resected and is used as a barrier against tumor cell dissemination in the process of colon cancer resection. If peritoneal metastases are visualized at any site, HIPEC should be included as part of the treatment package.
CONCLUSIONS: I am convinced that patients at high risk of recurrence will have an improved outcome with proper preoperative evaluation, preoperative neoadjuvant chemotherapy, and a revised intraoperative management strategy.
摘要：
背景：结肠癌患者可能存在于疾病过程的多个不同阶段。由于通常通过微创技术进行的简单外科手术，许多患者可以治愈结肠癌。然而,有不同数量的病人，估计约为10%，患有更晚期疾病的人。如果这些患者按照目前的常规护理标准进行治疗，治疗失败的可能性极高。
方法：这些患者不是已知播散性疾病的患者，而是疾病复发的高风险患者，除非在术前和术中开始特殊治疗。这些患者的识别是通过（1）高质量的CT扫描，（2）术前发现肿瘤标志物，（3）结肠镜检查结果，（4）症状。
结果：被确定为高风险的患者需要特殊的术前治疗，包括新辅助化疗。如果活检记录了腹膜转移，则应将HIPEC的术中化疗作为治疗的一部分。在手术室里,需要对转移性疾病的所有可能的隐匿性腹膜间隙进行彻底探索。进行改良的细胞减灭术以及结肠切除术，以最大程度地减少隐匿性腹膜转移的部位。这包括大网膜，卵巢,和绝经后妇女的管子。腹膜切除术用于在肿瘤周围形成护罩，以便切除与肿瘤表面直接接触的所有腹膜，并在结肠癌切除过程中用作抵抗肿瘤细胞扩散的屏障。如果在任何部位都能看到腹膜转移，HIPEC应作为治疗包的一部分。
结论：我确信，通过适当的术前评估，高复发风险患者的预后会得到改善。术前新辅助化疗,和修订的术中管理策略。
方法：这些患者不是已知播散性疾病的患者，而是疾病复发的高风险患者，除非在术前和术中开始特殊治疗。这些患者的识别是通过（1）高质量的CT扫描，（2）术前发现肿瘤标志物，（3）结肠镜检查结果，（4）症状。
结果：被确定为高风险的患者需要特殊的术前治疗，包括新辅助化疗。如果活检记录了腹膜转移，则应将HIPEC的术中化疗作为治疗的一部分。在手术室里,需要对转移性疾病的所有可能的隐匿性腹膜间隙进行彻底探索。进行改良的细胞减灭术以及结肠切除术，以最大程度地减少隐匿性腹膜转移的部位。这包括大网膜，卵巢,和绝经后妇女的管子。腹膜切除术用于在肿瘤周围形成护罩，以便切除与肿瘤表面直接接触的所有腹膜，并在结肠癌切除过程中用作抵抗肿瘤细胞扩散的屏障。如果在任何部位都能看到腹膜转移，HIPEC应作为治疗包的一部分。
结论：我确信，通过适当的术前评估，高复发风险患者的预后会得到改善。术前新辅助化疗,和修订的术中管理策略。
