second-look surgery for colorectal cancer revised selection factors and new treatment options for greater success重新审视结直肠癌手术修正选择因素和新的治疗方案,更大的成功.pdfVIP

Hindawi Publishing Corporation International Journal of Surgical Oncology Volume 2011, Article ID 915078, 8 pages doi:10.1155/2011/915078 Review Article Second-Look Surgery for Colorectal Cancer: Revised Selection Factors and New Treatment Options for Greater Success Paul H. Sugarbaker Washington Cancer Institute, 106 Irving Street, NW, Suite 3900, Washington DC,WA 20010, USA Correspondence should be addressed to Paul H. Sugarbaker, paul.sugarbaker@ Received 10 August 2010; Accepted 18 October 2010 Academic Editor: E. W. Martin Copyright © 2011 Paul H. Sugarbaker. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Proper indications for second-look surgery in patients with colorectal cancer have always been a controversial subject. The surgical literature suggests benefit in a reoperation, where a limited extent of cancer is discovered and then resected with negative margins. However, patients are often subjected to a negative exploratory laparotomy or an intervention that is unable to achieve an R-0 resection; in these circumstances, little or no benefit occurs. Unfortunately, an unsuccessful repeat intervention may place the patient in a worse condition, especially if morbidity occurs. This paper seeks to identify the clinical parameters of a primary colorectal cancer and a followup plan that are associated with cancer recurrence that can be definitively addressed by the second look surgery. New surgical technologies, including cytoreductive surgery with peritonectomy and perioperative intraperitoneal chemotherapy with hyperthermia, are suggested for use in this group of patients. This new management strategy used in patie