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Second-look surgery plus hyperthermic intraperitoneal chemotherapy for patients with colorectal cancer at high risk of peritoneal carcinomatosis:Does it really save lives?

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World Journal of Gastroenterology 2017年第3期23卷 377-381页

作者： Delia Cortes-Guiral dominique elias Pedro Antonio Cascales-Campos Alfredo Badía Yébenes Ismael Guijo Castellano Ana Isabel León Carbonero JoséIgnacio Martín Valadés Jesus Garcia-Foncillas Damian Garcia-Olmo Department of General Surgery(Peritoneal Surface Surgical Oncolongy) Fundación Jiménez Díaz Hospital28050 MadridSpain Department of Surgical Oncology Institut Gustave Roussy94805 VillejuifCédexFrance Department of General Surgery(Peritoneal Surface Surgical Oncolongy) Virgen de la Arrixaca30120 MurciaSpain Department of Medical Oncology Fundación Jiménez Díaz Hospital28050 MadridSpain

The treatment of peritoneal carcinomatosis (PC) of colorectal origin with cytoreductive surgery(CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has a 5-year recurrence-free or cure rate of at least 16%, so it is no longer labeled as a fatal disease, and offers prolonged survival for patients with a low peritoneal carcinomatosis index. Metachronous PC of colorectal origin is so predictable that there is a model which has been used to successfully determine the individual risk of each patient. Patients at risk are clearly identified; those with the highest risk have small peritoneal nodules present in the first surgery (70% probability of developing PC), ovarian metastases(60%), perforated tumor onset or intraoperative tumor rupture(50%). Current clinical, biological and imaging techniques still lack sufficient sensitivity to diagnose PC in its initial stages, when CRS plus HIPEC has a greater impact and a higher cure rate. Second-look surgery with HIPEC or prophylactic HIPEC at the time of the first intervention have been proposed as means of preventing and/or anticipating clinical or radiological relapse in at-risk patients. Both techniques have shown a significant decrease in peritoneal relapses and should be considered essential weapons in the management of colorectal cancer.

关键词： Second-look surgery High-risk patients Peritoneal carcinomatosis Hyperthermic intraperitoneal chemotherapy Colo-rectal cancer

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Volumetric Modifications of Metastatic Liver Volumes after Dramatic Responses under Chemotherapy

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Surgical Science 2012年第3期3卷 126-130页

作者： dominique elias Léon Maggiori Pascuale Misitano Frederic Deschamps Frédéric Dumont Michel Ducreux Diane Goéré Departments of Oncologic Surgery of Interventional Radiology and Medical Oncology Institut Gustave Roussy Villejuif France Departments of Oncologic Surgery of Interventional Radiology and Medical Oncology Institut Gustave Roussy Villejuif France

Objective: To analyze the volumetric modifications of the non tumourous part of the liver when liver metastases (LM) decrease under chemotherapy. Methods: Patients were highly selected based on the following criteria: multiple bilateral large colorectal LM, response of LM attaining at least 85% under chemotherapy. The volumes and ratios of the whole liver, of the LM, and mainly of the non tumourous (normal) part of the liver, were measured on CT scan before and after chemotherapy. Results: Only ten (5%) among 198 treated patients were eligible. Nine of them had received intra-arterial chemotherapy. Metastatic involvement was initially 34% before chemotherapy (range: 13% - 75%), and was 5% (range: 1% - 25%) after chemotherapy. The whole liver volume decreased by 41% (range: 23% - 68%) after chemotherapy. The non metastatic liver (volume and ratio) decreased after chemotherapy in 6 patients and increased in 4 patients. The volume and ratio increased in the 4 patients whose disease initially exhibited the highest metastatic involvement (p = 0.01). Conclusion: The volume of the non metastatic part of the liver varied slightly under standard chemotherapy. Intra-arterial chemotherapy induces dramatic responses, but also liver injury which impairs liver regeneration. However increasing volumes were observed when initial tumour involvement was major.

关键词： Liver Volume Colorectal Metastases Response under Chemotherapy

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肝脏切除术治疗非结直肠癌、非内分泌肿瘤来源的转移性肝癌：1452例患者的资料分析和预后模型的建立

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医学信息（手术学分册） 2007年第9期20卷 802-802页

作者： Adam, Rene Chiche, Laurence Aloia, Thomas elias, dominique Salmon, Remy Rivoire, Michel Jaeck, Daniel Saric, Jean Le Treut,Yves Patrice Belghiti, Jacques Mantion, Georges Mentha, Gilles the Association Francaise de Chirurgie

研究目的：明确肝脏切除术（HR）在非结直肠、非内分泌肿瘤来源的转移性肝癌（NCNELM）患者中的治疗作用。背景资料总结：HR在NCNELM患者中的治疗地位仍有争议，主要原因在于先前发表的报道有限，同时肿瘤原发部位与组织学存在异质性。... 详细信息

研究目的：明确肝脏切除术（HR）在非结直肠、非内分泌肿瘤来源的转移性肝癌（NCNELM）患者中的治疗作用。背景资料总结：HR在NCNELM患者中的治疗地位仍有争议，主要原因在于先前发表的报道有限，同时肿瘤原发部位与组织学存在异质性。方法：在1983—2004年间，对1452例接受HR的NCNELM患者进行预后因素和长期疗效分析，在此基础上建立多变量风险模型。研究结果：56％患者为肝脏孤立转移灶；71％为单侧（平均直径50．5mm）。

关键词：非内分泌肿瘤肝脏切除术转移性肝癌治疗作用结直肠癌预后模型原发部位疗效分析

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