Postoperative peritoneal recurrence of gastrointestinal cancer mechanism

By | March 30, 2012

Postoperative peritoneal recurrence of gastrointestinal cancer mechanisms, gastric cancer is one of the most common malignant tumors, the morbidity and mortality in the front rank various types of cancer, postoperative recurrence rate, which is most prevalent peritoneal recurrence , diffuse, poorly differentiated type and Borrmann4 postoperative peritoneal recurrence of gastric cancer rate 60% -70%; intestinal type and well-differentiated gastric cancer recurrence rate of postoperative peritoneal slightly lower, at 20% -30%. The overall operation of advanced gastric cancer peritoneal recurrence rate of 50%. The traditional treatment, surgery, radiotherapy, chemotherapy, the efficacy of peritoneal metastases was not significant, so how to take positive and effective measures to prevent and cure cancer metastasis and recurrence of peritoneal cancer surgery has become an important issue solved. Developed in recent years with intraperitoneal hyperthermic chemotherapy Technology (IPCH) is highly regarded in the treatment, which combines regional chemotherapy, the anticancer effect of hyperthermia and hyperthermia full advantage of the synergy with chemotherapy, both in prevention or treatment of advanced gastrointestinal cancer peritoneal metastasis or recurrence after surgery, the effects were significant, and the toxic side effects, easy to operate, has become a surgical adjuvant therapy.
Postoperative peritoneal recurrence of gastrointestinal cancer mechanisms, the current widely accepted cause of peritoneal recurrence of gastrointestinal cancer after the primary mechanism for the "seed – soil" theory, first off Rufu cavity cancer cell lines to form a recurrence "Seeds." Peritoneum is the mesothelial tissue, from the flat mesothelial cells and connective tissue, the connection between the skin cells and loose tissue as desmosomes, microvilli-rich surface, turn down to the basement membrane and collagen fibers formed by the large number of inter- stroma, during fibroblast cells contain a small amount of macrophages and lymphocytes. Surgical anatomy of the peritoneal surface due to mechanical damage, etc., so that the exposed peritoneal subcutaneous connective tissue, forming a cell easy to grow "soil."
Has been demonstrated in intra-abdominal free cancer cells have the ability to survive. At the same time, surgical trauma and wound healing process can promote cancer cell grown in the peritoneum. Early in wound healing, a lot of leakage of plasma fibrin to form a so-called "sediment trap cancer cells," fibrin-like exudate wrapped tumor cells form a "protective barrier" to prevent the immune phagocytosis activity. In the process because there is a variety of cell surface adhesion molecules, and further promote the proliferation of implantation in the peritoneum and thus, integrin (integrin, integrine) can promote tumor cell attachment protein. Infiltration of inflammatory cells and growth factors stimulate the easily grown in the peritoneal tumor cells, growth and proliferation. Epilepsy, wound healing scar tissue formed by the further inclusion and protection of the tumor cells. These factors caused the conventional intra-abdominal lavage can not remove these cancer cells.
Postoperative peritoneal recurrence of gastrointestinal cancer mechanisms, cancer cells off the main way Rufu cavity include: cancer invasion to the serosal layer, which may come off Rufu cavity. separated peritoneum and omentum is rich in lymphatics, the process of being cut off surgery on lymphatic tissue and intravascular thrombus with the lymph and blood cells can overflow Rufu cavity, with the progress of the tumor, lymphatic and blood vessel cancer increased, so the overflow Rufu cavity surgery significantly increased the chance. Found that some clinical and serosal invasion of gastric cancer has not, in the future but also the cultivation of peritoneal recurrence is clearly related to this factor. patients with gastrointestinal fluid in the overflow Rufu cavity.

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