Archivo PDF (1,90 MB) - AEC_____Asociación Española de Cirujanos

Executive summary
Objectives: To assess the efficacy and safety of the Sugarbaker procedure in
the treatment of peritoneal carcinomatosis secondary to colorectal cancer,
ovarian cancer, pseudomyxoma peritonei, abdominal sarcoma, malignant
mesothelioma and gastric cancer.
Type of intervention: Maximal cytoreductive surgery and concomitant perioperative
intraperitoneal chemotherapy with or without hyperthermia
(Sugarbaker procedure), compared with conventional treatment.
Study design: Global systematic review (overview).
Methodology: Bibliographic search of the most recent systematic reviews, and
the studies that update them. Sources searched were MEDLINE (accessed
through PubMed), EMBASE (accessed through Ovid) and CENTRAL, up to
year 2007. Assessment of methodological quality and level of evidence of the
identified systematic reviews (AMSTAR tool), clinical trials and case series
(SIGN scale). Description of study results.
Results: 1.619 publications were identified, 43 of whom verified the overview
inclusion criteria. There is evidence from randomized clinical trials proving
that the Sugarbaker procedure is superior to conventional treatment in
terms of survival, for peritoneal carcinomatosis secondary to colorectal or
gastric cancer. Evidence of the intervention efficacy for peritoneal carcinomatosis
secondary to ovarian cancer, pseudomyxoma peritonei or malignant
peritoneal mesothelioma emerges from uncontrolled case series and is
inconclusive. A small randomized trial in peritoneal sarcomatosis failed to
show a benefit of the Sugarbaker procedure. There are little data available
on quality of life and the results are difficult to assess.
Conclusions: To obtain a deeper understanding of some important therapeutic
issues related to carcinomatosis secondary to colorectal and gastric
cancer, and to assess the efficacy of the Sugarbaker procedure in the rest of
conditions, international multicentric randomized clinical trials with adequate
sample size are needed.
Key points
• Peritoneal carcinomatosis is a severe clinical condition that is being progressively
treated in specialized hospitals in many countries through a
combination of maximal cytoreductive surgery and concomitant periop-
RevisiÓn sistemÁtica del tRatamiento combinado multidisciplinaR
en las enfeRmedades malignas del peRitoneo 15