Advances in the management of peritoneal malignancies
Peritoneal surface malignancies (PSMs) are usually associated with a poor prognosis. Nonetheless, in line with advances in the management of most abdominopelvic metastatic diseases, considerable progress has been made over the past decade. An improved understanding of disease biology has led to the...
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| Vydané v: | Nature reviews. Clinical oncology Ročník 19; číslo 11; s. 698 - 718 |
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| Hlavní autori: | , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
London
Nature Publishing Group UK
01.11.2022
Nature Publishing Group |
| Predmet: | |
| ISSN: | 1759-4774, 1759-4782, 1759-4782 |
| On-line prístup: | Získať plný text |
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| Shrnutí: | Peritoneal surface malignancies (PSMs) are usually associated with a poor prognosis. Nonetheless, in line with advances in the management of most abdominopelvic metastatic diseases, considerable progress has been made over the past decade. An improved understanding of disease biology has led to the more accurate prediction of neoplasia aggressiveness and the treatment response and has been reflected in the proposal of new classification systems. Achieving complete cytoreductive surgery remains the cornerstone of curative-intent treatment of PSMs. Alongside centralization in expert centres, enabling the delivery of multimodal and multidisciplinary strategies, preoperative management is a crucial step in order to select patients who are most likely to benefit from surgery. Depending on the specific PSM, the role of intraperitoneal chemotherapy and of perioperative systemic chemotherapy, in particular, in the neoadjuvant setting, is established in certain scenarios but questioned in several others, although more prospective data are required. In this Review, we describe advances in all aspects of the management of PSMs including disease biology, assessment and improvement of disease resectability, perioperative management, systemic therapy and pre-emptive management, and we speculate on future research directions.
Peritoneal surface malignancies (PSMs) typically have a poor prognosis, although considerable advances in the understanding and management of these malignancies have been made over the past decade. This Review comprehensively describes the improvements in knowledge of the biology, assessment and classification, perioperative and surgical management, systemic treatment and pre-emptive management of PSMs. The authors also outline future directions for research in this field.
Key points
Pathological, molecular and genetic biomarkers should be integrated into the selection processes for appropriate multidisciplinary, palliative or curative management of peritoneal surface malignancies (PSMs).
Centralization of curative treatment in PSM-specific expert centres is needed to decrease the incidence of postoperative complications and improve survival outcomes owing to better patient selection, surgical expertise and perioperative care.
The combination of functional imaging (MRI, PET–CT) with appropriate laparoscopy improves the preoperative assessment of resectability of patients with peritoneal metastases, which is the most important determinant of eligibility for curative treatment.
Perioperative prehabilitation and enhanced postoperative recovery (ERAS) pathways should be integrated into curative management, especially in patients >70 years of age who require specific comprehensive geriatric assessments.
Intraperitoneal chemotherapy (HIPEC, PIPAC, NIPEC or EPIC) has an important role in the management of PSM and requires further evaluation in the neoadjuvant, consolidative therapy and pre-emptive settings.
The role of perioperative systemic chemotherapy, targeted therapy and immunotherapy should be evaluated in specific studies involving patients with PSMs, considering the common chemoresistance to systemic treatments in these patients. |
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| Bibliografia: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Review-3 content type line 23 |
| ISSN: | 1759-4774 1759-4782 1759-4782 |
| DOI: | 10.1038/s41571-022-00675-5 |