Sitoredüktif Cerrahi ve Hipertermik İntraperitoneal Kemoterapi
Özet
Sitoredüktif cerrahi (SRC) ve hipertermik intraperitoneal kemoterapi (HİPEK), periton tutulumu gösteren primer veya sekonder sindirim sistemi ve jinekolojik malignitelerin tedavisinde kullanılan kombine bir yaklaşımdır. SRC'nin amacı batın içinde makroskopik düzeyde tümör bırakmayacak şekilde tümöral doku ve organların çıkarılmasıyken, HİPEK ise 40-42°C sıcaklıkta uygulanan yüksek konsantrasyonlu kemoterapi ile mikroskobik tümör hücrelerini hedef alarak tedaviyi tamamlar. Başarıdaki en önemli unsur uygun hasta seçimi olup; psödomiksoma peritonei, diffüz peritoneal malign mezotelyoma, kolorektal, mide ve over kanserleri ile peritoneal sarkomatozis gibi klinik durumlarda kullanımı mevcuttur. Tedavinin etkinliği tümörün primer tipine ve cerrahinin başarısına göre değişmekle birlikte, özellikle Sugarbaker tarafından tanımlanan Sitoredüksiyon Tamamlanma Skorunun (CC) optimum düzeyde (CC-0/CC-1) olması en önemli prognostik faktördür. Sağkalım üzerinde önemli avantajlar sunmasına karşın prosedür; ince bağırsak fistülleri, anastomoz kaçakları, plevral efüzyon gibi pulmoner komplikasyonlar ve nötropeni başta olmak üzere %4-39 oranında hematolojik toksisite gibi ciddi morbidite risklerini barındırır. Bu komplikasyonların sıklığı merkezlerin deneyimi, cerrahi ekip uzmanlığı, uygulanan perfüzyon protokolleri ve multidisipliner yaklaşımla yakından ilişkilidir.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) represent a combined therapeutic approach utilized in managing primary or secondary gastrointestinal and gynecological malignancies demonstrating peritoneal involvement. While the primary objective of CRS is the optimal resection of tumoral tissues and organs to eliminate macroscopic disease within the intra-abdominal cavity, HIPEC complements this by targeting microscopic tumor cells utilizing highly concentrated chemotherapeutic agents perfused at a stable temperature of 40-42°C. Rigorous patient selection remains the most critical determinant of clinical success, and the procedure is currently indicated for conditions including pseudomyxoma peritonei, diffuse peritoneal malignant mesothelioma, colorectal, gastric, and ovarian cancers, as well as peritoneal sarcomatosis. The therapeutic efficacy varies depending on the primary tumor biology and surgical radicality; specifically, achieving an optimal score on Sugarbaker’s Completeness of Cytoreduction (CC) scale (CC-0 or CC-1) is established as the key prognostic factor. Despite offering significant survival benefits, this aggressive procedure carries substantial morbidity risks, including gastrointestinal complications such as small bowel fistulas and anastomotic leaks, pulmonary complications like pleural effusion, and hematological toxicities—particularly neutropenia, which ranges between 4% and 39%. The incidence and severity of these adverse events are heavily influenced by institutional experience, surgical team learning curves, specific perfusion protocols, and comprehensive multidisciplinary patient management.
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