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Chirurgie à visée curative des métastases péritonéales

Curative surgery for peritoneal metastases

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Oncologie

Résumé

L’exérèse complète des métastases péritonéales (MP), suivie de chimiohyperthermie intrapéritonéale (CHIP, dont l’impact thérapeutique précis n’est pas encore connu), permet d’obtenir de nombreuses guérisons chez les patients éligibles. C’est devenu le standard thérapeutique lorsqu’elle est possible. Ces résultats en termes de survie sont strictement identiques à ceux des hépatectomies pour métastases hépatiques (MH). La survie des patients présentant des MP débutantes est particulièrement bonne, bien supérieure à celle de tout patient hépatectomisé pour MH. La principale avancée sera de savoir opérer tôt les patients présentant des MP débutantes ou ceux qui ont un haut risque de développer des MP. Le concept de second-look + CHIP découle tout logiquement de ce constat. À l’opposé, une exérèse incomplète des MP contre-indique la CHIP, de même qu’une extension péritonéale importante (même si elle est complètement résécable).

Abstract

The complete resection of the peritoneal metastases (PM), followed with HIPEC (hyperthermic intraperitoneal chemotherapy, whose precise therapeutic impact is not yet well-known), allows to obtain numerous cures in eligible patients. This is currently the gold-standard treatment when it is possible. Its survival results are strictly similar to those obtained with hepatectomy for liver metastases (LM). The survival rate of the patients with early PM is particularly high, far superior to those of any hepatectomized patient. The main progress will be to early-operate these patients, or to propose a prophylactic approach to those presenting a high-risk to develop PM. The concept of second-look surgery + HIPEC is the logical extension of this combined approach. In contrast, a non-complete cytoreductive surgery and a large peritoneal extension are contraindications to use this approach.

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Authors and Affiliations

  1. Comité multidisciplinaire de cancérologie digestive, Gustave-Roussy, Cancer Campus, Grand Paris, rue Édouard-Vaillant, F-94805, cedex, Villejuif, France

    D. Elias, D. Goéré, C. Honoré, D. Malka, V. Boige, P. Burtin & M. Ducreux

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  1. D. Elias
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  2. D. Goéré
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  3. C. Honoré
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  4. D. Malka
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  5. V. Boige
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  6. P. Burtin
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  7. M. Ducreux
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Correspondence to D. Elias.

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Elias, D., Goéré, D., Honoré, C. et al. Chirurgie à visée curative des métastases péritonéales. Oncologie 16, 543–548 (2014). https://doi.org/10.1007/s10269-014-2465-4

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  • DOI: https://doi.org/10.1007/s10269-014-2465-4

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