№67. Cytoreductive surgery in disseminated tumors
Surgical decision making in treating patients with metastatic tumors. focus on surgical treatment of peritoneal carcinomatosisO.E. Kalinin, V.V. GushchinDOI 10.31917/1703119
Surgeons are keyplayers in multidisciplinary care for patients with stage IV and metastatic malignancies of various origins. The tumor biology such as pattern and rate of growth, response to multimodality treatment defines surgical reasoning behind a certain type of surgical intervention. Depending on the treatment goal surgeons perform curative, palliative, and cytoreductive procedures. When analyzing the medical literature and using international treatment guidelines (such as the NCCN guidelines) it is paramount to have common understanding of the definitions and to share the logic behind them. This article walks the reader through the main questions that surgeons commonly face in caring for patients with metastatic disease. It is focused particularly on the cytoreductive approach in treatment of appendiceal and advanced ovarian cancers. The authors advocated a systematic approach to organizing programs for treatment of the challenging patients with metastatic tumors. This may not only improve the clinical outcomes but also would build a foundation for advancing the actively researched field of surgical oncology.
Keywords: peritoneal carcinomatosis, cytoreductive surgery, curative surgery, palliative surgery, hyperthermic intraperitoneal chemotherapy, HIPEC, stage IV cancer, metastatic disease
- P.V. Balakhnin, A.S. Shmelev, E.G. ShachinovDOI 10.31917/1703129
Percutaneous energy-based ablation is a promising minimally invasive treatment of unresectable primary and metastatic tumors of different localizations. This article analyzes the basic principles of the interventions, as well as existing technologies that used for hyperthermic (laser, ultrasound, radiofrequency and microwave ablation), hypothermic (cryoablation) and non-thermal (photodynamic ablation, irreversible electroporation) tumor ablation. The authors discussed the mechanisms of the impact of various types of energy to the tissue, and the advantages and disadvantages of their clinical use. The longterm results of treatment of tumors of the liver, kidney, lung and tumors of other localizations were analyzed in the article. The authors considered the modern ideas of the impact of different types of ablation on the immune system, as well as the potential use of ablative technologies in combination with various methods of cancer immunotherapy.
Keywords: radiofrequency ablation, microwave ablation, cryoablation, irreversible electroporation, laser ablation, ultrasound ablation, cancer immunotherapy, interventional radiology
- M.Ju. FedyaninDOI 10.31917/1703154
This article analyzes results of studies concerning the controversial issues of performing cytoreductive surgery for patients with metastatic gastrointestinal cancers. We discussed data not only for primary tumor dissection in metastatic disease, but also necessity of metastasectomy in different settings. Also we discussed modern algorithm of cytoreductive approaches in esophageal cancer, gastric cancer and colorectal cancer.
Keywords: esophageal cancer, gastric cancer, colorectal cancer, cytoreductive surgery, metastatic tumor, metastasectomy
- V.V. Egorenkov, M.S. Molchanov, K.A. AndreychukDOI 10.31917/1703177
Currently, there is no gold standard for treatment of stage IV melanoma. Surgical therapy for stage IV disease remains controversial. Conventional teaching maintains that surgical management is not indicated in patients with distant metastases, except for palliation. The rationale for surgical resection of metastatic melanoma is multifactorial. Stringent patient selection is essential. The advent of newer and better systemic therapies makes the role of surgical resection more relevant today than ever before.
Keywords: stage IV, melanoma, surgery
- S.Ya. Maximov, I.V. Sobolev, A.S. Hadjimba, A.A. Ilin, E.D. Gershfeld, D.-K. Reyes SantiagoDOI 10.31917/1703184
The authors determine feasibility of cytoreductive surgery for women with gynecological cancer. The article analyzes world statistical data and data of personal surveys.
For ovarian cancer benefits of complete cytoreductive surgery were shown regardless of order in complex treatment. Question about lymph node dissection is still opened. The article shows that performing lymphadenectomy during interval cytoreduction and in case of suboptimal surgery does not improve prognosis in overall survival.
For endometrial cancer importance of debulking surgery was assessed for primary treatment and for relapse. Progression free survival increased only in case of complete cytoreduction but there aren’t significant benefits for long-term outcome.
For cervical cancer advantage of surgery was shown comparing with chemotherapy and radiotherapy what was confirmed by results of own surveys.
Cytoreductive surgery in gynecological cancer is feasible in complex treatment. Moreover, complete cytoreduction has significant benefits in survival for oncological patients.
Keywords: cytoreductive, debulking surgery, ovarian cancer, cervical cancer, endometrial cancer, chemotherapy, radiotherapy
- M.P. NikulinDOI 10.31917/1703200
The theory of «oligometastatic disease» was proposed for the first time by Hellman S. И Weichselbaumin in 1995 and meant intermediated state between localized tumor and metastatic disease. Last decades demonstrated patients with solitary metastases who lived for a long time and surgery treatment revealed potential benefit. For example, breast and prostate cancer patients with distant metastases survived 5 and even 10 years. The decrease of tumor burden theoretically could improve prognosis. So, the therapy directed to solitary metastases, particularly surgery treatment afford not only to remove cancer clones, but in some cases to delay toxic chemotherapy or hormone therapy. In prostate cancer patients metastasectomy usually performed in positive pelvis or retroperitoneal lymph nodes, in breast cancer patients – in visceral (liver, pulmonary, brain) oligometastases. Multimodality treatment in such patients in nonrandomized trials complicates the estimation of effectiveness of each method. The indications for oligometastasis surgery to date are: the disease-free interval after treatment of primary tumor, the number and site of metastases, hormone status. This article discussed the literature data of oligometastatic surgery in breast and prostate cancer patients.
Keywords: breast cancer, prostate cancer, surgery, oligometastasis, oligometastases, oligometastatic, metastasectomy, solitary metastases