Skip to main content
Log in

Peritonealkarzinose beim Magenkarzinom

Rolle der Chirurgie und HIPEC

Peritoneal carcinomatosis and gastric cancer

Role of surgery and HIPEC

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Das Magenkarzinom weist eine Inzidenz von 24,2 Neuerkrankungen pro 100.000 Einwohner (Krebsregister 2011) in Deutschland auf. Bei ca. 15 % der Patienten kann zum Zeitpunkt der Erstdiagnose bereits eine Peritonealkarzinose nachgewiesen werden.

Fragestellung

Für Patienten mit einem pertinoneal metastasierten Magenkarzinom kann die Möglichkeit einer zytoreduktiven Therapie und hyperthermen intraperitonealen Chemoptherapie (HIPEC) evaluiert werden. Welche Patienten für diese Therapie in Frage kommen und zu welchen Ergebnissen die zytoreduktive Chirurgie (CRS) und HIPEC führen kann, soll im Folgenden erläutert werden.

Material und Methode

Es wurde eine systematische Überprüfung der Literatur vorgenommen, mit Erarbeitung der Kriterien für Patienten, die für eine zytoreduktive Therapie mit HIPEC infrage kommen sowie der Herausarbeitung der Ergebnisse mit kurzem Ausblick über mögliche zukünftige Therapievarianten.

Ergebnisse

Der wichtigste Prognosefaktor für Patienten mit peritoneal metastasiertem Magenkarzinom ist die Möglichkeit einer kompletten Zytoreduktion. Durch eine multimodale Therapie, bestehend aus Chemotherapie, CRS und HIPEC, kann das mediane Überleben in einem selektionierten Patientengut signifikant gesteigert werden.

Schlussfolgerungen

Wegweisend für die Verbesserung des Patientenüberlebens ist die Patientenselektion im Rahmen einer multidisziplinären Gruppe von Spezialisten (Chirurg, Onkologe und Intensivmediziner), um ein optimales Therapieergebnis (komplette Zytoreduktion) für den einzelnen Patienten zu erreichen. Im onkologischen Setting ist eine neoadjuvante und adjuvante Chemotherapie sinnvoll, um die Rate an kompletten Zytoreduktionen zu verbessern und wohlmöglich die rezidivfreie Überlebenszeit und Gesamtüberlebenszeit zu verlängern.

Abstract

Background

The incidence of gastric cancer in Germany is 24.2 per 100,000 inhabitants per year (cancer registry 2011) and in 15 % of these patients peritoneal carcinomatosis is simultaneously detected at the time of the primary diagnosis.

Objective

Patients with peritoneal carcinomatosis due to metastases from gastric cancer should be evaluated for the possibility of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). The indications and outcome for cytoreductive surgery and HIPEC are discussed in this paper.

Methods

The study included a systematic review of the literature and development of criteria which simplify the decision of patient selection for cytoreductive surgery and HIPEC. This review highlights the patient outcome and outlines possible future diagnostic and therapeutic options.

Results

Completeness of cytoreductive surgery is the most important prognostic factor for patients with peritoneal carcinomatosis from metastasized gastric cancer. The median survival time can be significantly prolonged in selected patients from 1–3 months to 11 months using a multimodal therapeutic regimen including chemotherapy, cytoreductive surgery and HIPEC.

Conclusion

To achieve an optimal outcome (complete cytoreduction) with improvement in patient survival, patient selection performed by a multidisciplinary group of specialists (e.g. surgeon, oncologist and anesthesiologist) is crucial. Neoadjuvant and adjuvant chemotherapy is generally recommended in order to achieve an improved rate of complete cytoreduction and to potentially prolong disease-free and overall survival times.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Okines A, Verheij M, Allum W et al (2010) Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v50–v54

    Article  PubMed  Google Scholar 

  2. Yonemura Y, Elnemr A, Endou Y et al (2010) Multidisciplinary therapy for treatment of patients with peritoneal carcinomatosis from gastric cancer. World J Gastrointest Oncol 2(2):85–97

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sugarbaker PH (1988) Surgical management of peritoneal carcinosis: diagnosis, prevention and treatment. Langenbecks Arch Chir 373(3):189–196

    Article  CAS  PubMed  Google Scholar 

  4. Sugarbaker PH (1989) Management of peritoneal carcinomatosis. Acta Med Austriaca 16(3–4):57–60

    CAS  PubMed  Google Scholar 

  5. Larkin JM, Edwards WS, Smith DE et al (1977) Systemic thermotherapy: description of a method and physiologic tolerance in clinical subjects. Cancer 40(6):3155–3159

    Article  CAS  PubMed  Google Scholar 

  6. Dedrick RL, Myers CE, Bungay PM et al (1978) Pharmacokinetic rationale for peritoneal drug administration in the treatment of ovarian cancer. Cancer Treat Rep 62(1):1–11

    CAS  PubMed  Google Scholar 

  7. Spratt JS, Adcock RA, Sherrill W et al (1980) Hyperthermic peritoneal perfusion system in canines. Cancer Res 40(2):253–255

    CAS  PubMed  Google Scholar 

  8. Spratt JS, Adcock RA, Muskovin M et al (1980) Clinical delivery system for intraperitoneal hyperthermic chemotherapy. Cancer Res 40(2):256–260

    CAS  PubMed  Google Scholar 

  9. Sugarbaker PH (1995) Peritonectomy procedures. Ann Surg 221(1):29–42

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sugarbaker PH (1996) Observations concerning cancer spread within the peritoneal cavity and concepts supporting an ordered pathophysiology. Cancer Treat Res 82:79–100

    Article  CAS  PubMed  Google Scholar 

  11. Sugarbaker PH (1998) Intraperitoneal chemotherapy and cytoreductive surgery for the prevention and treatment of peritoneal carcinomatosis and sarcomatosis. Semin Surg Oncol 14(3):254–261

    Article  CAS  PubMed  Google Scholar 

  12. Roviello F, Caruso S, Marrelli D et al (2011) Treatment of peritoneal carcinomatosis with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: state of the art and future developments. Surg Oncol 20(1):e38–e54

    Article  PubMed  Google Scholar 

  13. Sugarbaker TA, Chang D, Koslowe P et al (1996) Patterns of spread of recurrent intraabdominal sarcoma. Cancer Treat Res 82:65–77

    Article  CAS  PubMed  Google Scholar 

  14. Portilla AG, Sugarbaker PH, Chang D (1999) Second-look surgery after cytoreduction and intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal cancer: analysis of prognostic features. World J Surg 23(1):23–29

    Article  CAS  PubMed  Google Scholar 

  15. Elias D, Blot F, El Otmany A et al (2001) Curative treatment of peritoneal carcinomatosis arising from colorectal cancer by complete resection and intraperitoneal chemotherapy. Cancer 92(1):71–76

    Article  CAS  PubMed  Google Scholar 

  16. Tentes AA, Tripsiannis G, Markakidis SK et al (2003) Peritoneal cancer index: a prognostic indicator of survival in advanced ovarian cancer. Eur J Surg Oncol 29(1):69–73

    Article  PubMed  Google Scholar 

  17. Elias D, Gilly F, Boutitie F et al (2010) Peritoneal colorectal carcinomatosis treated with surgery and perioperative intraperitoneal chemotherapy: retrospective analysis of 523 patients from a multicentric French study. J Clin Oncol 28(1):63–68

    Article  PubMed  Google Scholar 

  18. Glehen O, Gilly FN, Arvieux C et al (2010) Peritoneal carcinomatosis from gastric cancer: a multi-institutional study of 159 patients treated by cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Ann Surg Oncol 17(9):2370–2377

    Article  PubMed  Google Scholar 

  19. Jafari MD, Halabi WJ, Stamos MJ et al (2014) Surgical outcomes of hyperthermic intraperitoneal chemotherapy: analysis of the american college of surgeons national surgical quality improvement program. JAMA Surg 149(2):170–175

    Article  PubMed  Google Scholar 

  20. Gill RS, Al-Adra DP, Nagendran J et al (2011) Treatment of gastric cancer with peritoneal carcinomatosis by cytoreductive surgery and HIPEC: a systematic review of survival, mortality, and morbidity. J Surg Oncol 104(6):692–698

    Article  PubMed  Google Scholar 

  21. Yonemura Y, de Aretxabala X, Fujimura T et al (2001) Intraoperative chemohyperthermic peritoneal perfusion as an adjuvant to gastric cancer: final results of a randomized controlled study. Hepatogastroenterology 48(42):1776–1782

    CAS  PubMed  Google Scholar 

  22. Fujimoto S, Takahashi M, Mutou T et al (1999) Successful intraperitoneal hyperthermic chemoperfusion for the prevention of postoperative peritoneal recurrence in patients with advanced gastric carcinoma. Cancer 85(3):529–534

    Article  CAS  PubMed  Google Scholar 

  23. Kim JY, Bae HS (2001) A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP). Gastric Cancer 4(1):27–33

    Article  CAS  PubMed  Google Scholar 

  24. Yan TD, Black D, Sugarbaker PH et al (2007) A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann Surg Oncol 14(10):2702–2713

    Article  PubMed  Google Scholar 

  25. Yang XJ, Huang CQ, Suo T et al (2011) Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy improves survival of patients with peritoneal carcinomatosis from gastric cancer: final results of a phase III randomized clinical trial. Ann Surg Oncol 18(6):1575–1581

    Article  PubMed  PubMed Central  Google Scholar 

  26. Coccolini F, Cotte E, Glehen O et al (2014) Intraperitoneal chemotherapy in advanced gastric cancer. Meta-analysis of randomized trials. Eur J Surg Oncol 40(1):12–26

    Article  CAS  PubMed  Google Scholar 

  27. Rau B (2014) Prospective multicentric phase III study. Z Gastroenterol 52(3):262

    Article  PubMed  Google Scholar 

  28. Braam HJ, Schellens JH, Boot H et al (2015) Selection of chemotherapy for hyperthermic intraperitoneal use in gastric cancer. Crit Rev Oncol Hematol 95(3):282–296

    Article  CAS  PubMed  Google Scholar 

  29. Yonemura Y, Endou Y, Shinbo M et al (2009) Safety and efficacy of bidirectional chemotherapy for treatment of patients with peritoneal dissemination from gastric cancer: selection for cytoreductive surgery. J Surg Oncol 100(4):311–316

    Article  CAS  PubMed  Google Scholar 

  30. Nissan A, Garofalo A, Esquivel J (2010) Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (HIPEC) for gastric adenocarcinoma: why haven’t we reached the promised land? J Surg Oncol 102(5):359–360

    Article  PubMed  Google Scholar 

  31. Wu Z, Ma S, Jing S et al (2014) Effect of Hyperthermic Intraperitoneal Perfusion Chemotherapy in Combination with Intravenous Chemotherapy as Postoperative Adjuvant Therapy for Advanced Gastric Cancer. Hepatogastroenterology 61(132):972–977

    PubMed  Google Scholar 

  32. Glehen O, Mohamed F, Gilly FN (2004) Peritoneal carcinomatosis from digestive tract cancer: new management by cytoreductive surgery and intraperitoneal chemohyperthermia. Lancet Oncol 5(4):219–228

    Article  PubMed  Google Scholar 

  33. Konstantinidis IT, Young C, Tsikitis VL et al (2012) Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion: The University of Arizona early experience. World J Gastrointest Surg 4(6):135–140

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to A. Brandl or Y. K. Vashist.

Ethics declarations

Interessenkonflikt

A. Brandl, F.G. Uzunoglu und Y.K. Vashist geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brandl, A., Uzunoglu, F.G. & Vashist, Y.K. Peritonealkarzinose beim Magenkarzinom. Onkologe 22, 413–418 (2016). https://doi.org/10.1007/s00761-016-0032-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00761-016-0032-6

Schlüsselwörter

Keywords

Navigation