III Convegno Congiunto delle Società Lombarda e Triveneta di Chirurgia La carcinosi peritoneale da...
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III Convegno Congiunto delle Società Lombarda e Triveneta di Chirurgia La carcinosi peritoneale da ca colorettale. Storia naturale, scenari clinici ed impatto prognostico D.Foschi
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Transcript of III Convegno Congiunto delle Società Lombarda e Triveneta di Chirurgia La carcinosi peritoneale da...
III Convegno Congiunto delle SocietàLombarda e Triveneta di Chirurgia
La carcinosi peritoneale da ca colorettale.Storia naturale, scenari clinici ed impatto prognostico
D.Foschi
Dipartimento di Scienze Cliniche L.SaccoUniversità di Milano
Desenzano 12 maggio 2012
Pathogenesis of peritoneal minimal residual disease
WP Ceelen, 2009
D
K.L. Sodek, 2012
Disease progression and metastatic spread
Author N. Patients P.C.
Russell (1984) 94 5 %Minsky (1988) 294 4 %Jayne (2002) 2756 7.7 %Lemmens (2010)* 18.738 4.8 %Mulsow (2011) 3138 4.8 %
Incidence of synchronous peritoneal carcinomatosis
W.E. Lemmens, Int J Cancer, 2011
Synchronous Peritoneal Carcinomatosis and Colorectal cancer
Anni 1995-2008
4.8%
43.6% 56.4%
W.E. Lemmens, Int J Cancer, 2011
General characteristics of patients with synchronous P.C.
0.1%
0.3%
21%
3.4%
Risk of P.C. : Multivariable logistic regression
W.E. Lemmens, Int J Cancer, 2011
Meta-analysis of overall and local recurrence for – vs + preresection PFCC
Rekhraj S,2008
Meta-analysis of overall and local recurrence for – vs + postresection PFCC
Rekhraj S,2008
PROGNOSTIC FACTORS FOR SURVIVAL IN P.C. FROM C.R.C.
Median (mos) Mean (mos) P value
Synchronous P.C. 4.1 6.0 P = 0.78
Not synchronous P.C. 5.3 6.2 NS
Initial pTNM staging
T1,T2 (n = 4) 7.3 9.3 T3 (n = 76) 5.3 7.2 P = 0.5 T4 (n = 38) 3.4 4.7 NS
Lymph node involvement
N0 8.7 10.2 P = 0.13 N+ 7 6.8 NSPC staging Stage I 12.5 14.3 Stage II 8.3 8.4 Stage III 4.4 6.0 P = 0.001 Stage IV 2.7 4.4Differentiation WD and MD 3.2 5.3 P = 0.9 PD and UD 5.5 5.3 NSAscites Yes 3.7 5.1 P = 0.6 No 5.1 6.5 NSLiver metastases Yes 4.4 6.1 P = 0.4 No 5.9 6.1 NS
B.Sadeghi, 2000 Cancer
Prognostic factors in metachronous ascites
DZJ Chu, Cancer, 1989
M:6 mnt
Crude survival of synchronous peritoneal carcinomatosis
V.E. Lemmens,2010
Incidence of metachronous peritoneal carcinomatosis
Author year N.Patients Met.P.C.
Cass 1976 280 28%Malcom 1981 285 13%Mendenhall 1983 140 12%Gilbert 1984 31 3%Tong 1984 64 44%Gunderson 1985 91 21%Jayne 2002 2756 4.8%________________________________________________Gilbert(autopsy ser.) 1984 45 40%Russell (autopsy ser.) 1985 53 36%________________________________________________Mulsow (CRC-PC) 2011 31 74%Matsuda (CRC-PC) 2012 31 77%
Logistic regression analysis for metachronous peritoneal carcinomatosis
Odds ratio P
Clinical
Liver metastasis 2.84 (1.7 – 4.6) <0.001
Histological
Tumor stage 2.74(1.6-4.5) <0.001Nodal stage 2.47(1.6-3.8) <0.001Venous invasion 2.07(1.1-2.3) <0.012Perineural invasion 1.57(1-2.3) <0.032
Jayne DG, 2002
Risk factors for metachronous P.C.
pT4Positive peritoneal cytologyPeritoneal seedingOvarian InvolvementPerforation of the tumorRupture of a necrotic tumor massIntraoperative tumor spill
Risk factors for metachronous P.C.
N.Patients Synchronous P.C. Ovarian Metastase Perforated tumorTot n:41 n:25 n: 8 n:8
% + P.C. 15(60%) 5 (62%) 3 (37%)
PCI 9±6 7±5 5±2
D. Elias, 2011
Risk of local recurrence after inadvertent rectal perforation
M.T. Eriksen, 2004
Synchronous colorectal PCN:153
Complete resectionN:31
Non complete resectionN:122
All recurrencesN:24 (77%)
1° site of recurrence
Intra-peritoneal aloneN. 8 (25.8%)
P.C. – extraperitonealN:1 (3.2%)
Extra-peritoneal aloneN:15 (48.4%)
Matsuda, 2012
Risk of metachronous carcinomatosis after CRC-PC resection
ROSMIF
TNF-αIL-1, -6, -8, -10
TGF-αbFGFTGF-β
Pathophysiology of ascites accumulation
K.L. Sodek, 2012
SurvivaL of P.C. after standard treatment or CRS-HIPEC
