gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2025-35-3-21-32gastro-j-1436Research ArticleОБЗОРЫREVIEWSПеритонеальный канцероматоз у больных местнораспространенным раком толстой кишки: обзор литературыPeritoneal Carcinomatosis in Patients with Locally Advanced Colon Cancer: Literature Reviewhttps://orcid.org/0000-0002-8019-0961ТрищенковС. Ю.TrishchenkovS. Yu.

Трищенков Сергей Юрьевич — врач-онколог, ассистент кафедры  хирургии Института клинической медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская, 1, стр. 1

 

Sergey Yu. Trishchenkov — Oncologist, Teaching Assistant at the Department of Surgery, N.V. Sklifosovsky Institute of Clinical Medicine

119435, Moscow, Pogodinskaya str., 1, build. 1

sergeyld2@gmail.comhttps://orcid.org/0009-0008-7870-8777ЛёвинаО. В.LevinaO. V.

Левина Ольга Владимировна — ординатор кафедры хирургии Института клинической медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская, 1, стр. 1

Olga V. Levina — Resident at the Department of Surgery, N.V. Sklifosovsky Institute of Clinical Medicine

119435, Moscow, Pogodinskaya str., 1, build. 1

Levina.o1999@mail.ruhttps://orcid.org/0000-0002-3192-3786НековальВ. М.NekovalV. M.

Нековаль Валерий Михайлович — кандидат медицинских наук, врач-колопроктолог Клиники колопроктологии и малоинвазивной хирургии Университетской клинической больницы № 2119435, г. Москва, ул. Погодинская, 1, стр. 1

Valeriy M. Nekoval — Cand. Sci. (Med.), Coloproctologist, Clinic of Coloproctology and Minimally Invasive Surgery, University Clinical Hospital No. 2

119435, Moscow, Pogodinskaya str., 1, build. 1

nekoval_v_m@staff.sechenov.ruhttps://orcid.org/0000-0002-7226-4641БалабанВ. В.BalabanV. V.

Балабан Владимир Владимирович — кандидат медицинских наук, доцент кафедры хирургии Института клинической медицины им. Н.В. Склифосовского, заведующий отделением колопроктологии Клиники колопроктологии и малоинвазивной хирургии

119435, г. Москва, ул. Погодинская, 1, стр. 1

Vladimir V. Balaban — Cand. Sci. (Med.), Associate Professor at the Department of Surgery, N.V. Sklifosovsky Institute of Clinical Medicine; Head of the Coloproctology Department, Clinic of Coloproctology and Minimally Invasive Surgery

119435, Moscow, Pogodinskaya str., 1, build. 1

balaban_v_v@staff.sechenov.ruhttps://orcid.org/0000-0002-7134-6821ЦарьковП. В.TsarkovP. V.

Царьков Петр Владимирович — доктор медицинских наук,профессор, заведующий кафедрой хирургии Института клинической медицины им. Н.В. Склифосовского

119435, г. Москва, ул. Погодинская, 1, стр. 1

Petr V. Tsarkov – Dr. Sci. (Med.), Professor, Head of the Department of Surgery, N.V. Sklifosovsky Institute of Clinical Medicine

119435, Moscow, Pogodinskaya str., 1, build. 1

tsarkov@kkmx.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenovskiy University)Russian Federation2025130820253532132Copyright © Трищенков С.Ю., Лёвина О.В., Нековаль В.М., Балабан В.В., Царьков П.В., 20252025Трищенков С.Ю., Лёвина О.В., Нековаль В.М., Балабан В.В., Царьков П.В.Trishchenkov S.Y., Levina O.V., Nekoval V.M., Balaban V.V., Tsarkov P.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1436

Цель: представить систематизированный анализ данных публикаций о методах диагностики и лечения больных местнораспространенным раком толстой кишки с перитонеальным канцероматозом.Основные положения. Даже очевидный и стремительный прогресс хирургических и лекарственных методов лечения больных местнораспространенным раком толстой кишки пока не гарантирует полного излечения. От 4 до 7 % больных после радикальной резекции отмечают прогрессирование заболевания — перитонеальный канцероматоз. Доля пациентов с изолированным поражением брюшины составляет порядка 2 % — такой процент выявления перитонеального канцероматоза на ранней стадии напрямую связан с недостаточной эффективностью диагностических методов, как лабораторных, так и инструментальных. На сегодняшний день хирургами накоплен богатый опыт проведения диагностических операций. Лапароскопия является мини-инвазивным диагностическим инструментом и играет важную роль в оценке степени диссеминации, поскольку позволяет детально визуализировать поверхность брюшины, выполнить биопсию/смывы брюшной полости, а также подсчитать индекс перитонеального канцероматоза (peritoneal carcinomatosis index, PCI).Вопрос ранней диагностики изолированного перитонеального канцероматоза по-прежнему актуален. И одним из точных методов диагностики мелкоочагового перитонеального канцероматоза является повторная диагностическая операция («second look»). Учитывая прямую связь между степенью тяжести перитонеального распространения и выживаемостью, можно предположить, что выявление перитонеального канцероматоза на ранней стадии увеличит долю пациентов, подходящих для радикального лечения, и улучшит выживаемость. К настоящему моменту проведено достаточное количество исследований, сравнивающих непосредственные и отдаленные результаты лечения больных колоректальным раком с применением различных комбинаций циторедуктивной хирургии с гипертермической интраперитонеальной химиотерапией и без таковой и/или системной химиотерапии.Заключение. Анализ результатов крупных рандомизированных исследований у пациентов с колоректальным раком, осложненным перитонеальным канцероматозом, с применением химиотерапии и в комбинации с таргетной терапией показывает хорошие результаты общей и безрецидивной выживаемости.

Aim: to analyse and systematise available literature data on the diagnosis and treatment of patients with locally advanced colon cancer with peritoneal carcinomatosis.Key points. Even the obvious and rapid progress in the development of surgical and medicinal methods of treating patients with locally advanced colon cancer does not yet guarantee a complete cure. From 4 to 7 % of patients after radical resection report the progression of the disease — peritoneal carcinomatosis. The proportion of patients with isolated peritoneal lesions is about 2 %. This percentage of detection of peritoneal carcinomatosis at an early stage is directly related to the insufficient effectiveness of diagnostic methods, both laboratory and instrumental. To date, surgeons have accumulated quite a wealth of experience in performing diagnostic operations. Laparoscopy is a minimally invasive diagnostic tool and plays an important role in assessing the degree of dissemination, as it allows detailed visualization of the peritoneal surface, performing abdominal biopsies/flushes, and calculating the peritoneal carcinomatosis index (PCI).The issue of early diagnosis of isolated peritoneal carcinomatosis is still relevant. and one of the most accurate methods of diagnosing small-focal peritoneal carcinomatosis is a repeated diagnostic operation (second look). Given the direct relationship between the severity of peritoneal spread and survival, it can be assumed that early detection of peritoneal carcinomatosis will increase the proportion of patients suitable for radical treatment and improve survival. To date, a sufficient number of studies have been conducted comparing the immediate and long-term results of treating patients with colorectal cancer using various combinations of cytoreductive surgery with/without hyperthermic intraperitoneal chemotherapy and/or systemic chemotherapy.Conclusion. Evaluation of the current results of the randomized clinical trials in patients with peritoneal carcinomatosis of colon origin, treated with chemotherapy and in combination with targeted therapy, show fairly good results in overall and relapse-free survival.

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The authors declare that there are no conflicts of interest present.