Abstract
Treatment of late stages of the tumor process requires the implementation of increasingly high-tech and complex interventions, aimed at improving the overall and disease-free survival, improving the quality of life of patients. HIPEC technique is a point of growth at which progress in oncology and all medical science can be demonstrated. Among the specialists involved in the implementation of this type of specialized care, there is still no consensus on what traits the malignant process of the peritoneum should be able to use this technique. Intraperitoneal hyperthermic perfusion (HIPEC) is gaining popularity as a method of palliative treatment of patients with common tumors of the abdominal cavity. Using the popular medical virtual search engine PubMed identified 2140 cited publications on the search query "hipec, peritoneal" and 752 cited publications "hipec, peritoneal, CRS", finally the phrase "hipec, cancer, randomized trial" with the clarifying characteristic "Clinical Trial" (excludes review articles) – 30 scientific publications, 10 of them in the last 5 years. All this demonstrates the growing interest to HIPEC around the world. The technique is used mainly for ovarian cancer, mesothelioma, pseudomyxoma of the peritoneum, colorectal cancer, and gastric cancer. It is possible as a combination of surgically performed PE and HIPEC, and HIPEC in mono-mode, in the absence of macroscopically detected carcinoma of the abdominal cavity, but positive washings from the peritoneum in verified cancer. It is performed both during the cytoreductive operation and as the second stage as a component of the Second look procedure, as well as in the adjuvant mode in the absence of carcinomatosis, but of high potential danger of peritoneal dissemination (for example, if the tumor has infiltrated the entire wall of the organ). HIPEC has never become a standard treatment, and multicenter randomized trials are regularly conducted on this topic.
Highlights
Лечение поздних стадий опухолевого процесса требует выполнения всё более высокотехнологичных и сложных вмешательств, направленных на улучшение общей и безрецидивной выживаемости, качества жизни больных
Chandrakumaran K. et al Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy improves survival in patients with colorectal peritoneal metastases compared with systemic chemotherapy
Glimelius B. et al Phase II study of patients with peritoneal carcinomatosis from gastric cancer treated with preoperative systemic chemotherapy followed by peritonectomy
Summary
Лечение поздних стадий опухолевого процесса требует выполнения всё более высокотехнологичных и сложных вмешательств, направленных на улучшение общей и безрецидивной выживаемости, качества жизни больных. Во время операции перитонеальную диссеминацию по брюшной полости оценили как тотальную у всех больных. Степень циторедукции оценивали по шкале полноты выполняемой циторедукции (шкала Harmon-Sugarbaker) от СС-0 до СС-3: СС-0, нет видимых перитонеальных отсевов после ПЭ; СС-1, оставшиеся опухолевые узлы размером менее 0,25 см; СС-2, оставшиеся опухолевые очаги размером от 0,25 до 2,5 см; СС-3, узлы соответственно более 2,5 см; СС-0 у 3 больных, СС-1 – у 3 и у 1 больного, при выраженном канцероматозе степень полноты циторедукции оценивали как СС-3 Важной особенностью является необходимость закрытия культи прямой кишки (линейный ушиватель органов УО/60 «Красногвардеец» или аппарат Contour Curved Cutter Stapler, Ethicon) и культи влагалища для устранения вероятности вытекания раствора химиопрепарата из брюшной полости. Особенностью современной процедуры ВБГТХП является равномерное распределение химиопрепарата по брюшной полости
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