Background: Peritoneal metastasis represents an aggressive disease pattern in pancreatic ductal adenocarcinoma (PDAC), traditionally associated with poor survival and limited therapeutic options. Emerging intraperitoneal chemotherapy strategies—including hyperthermic intraperitoneal chemotherapy (HIPEC), normothermic intraperitoneal paclitaxel (NIPEC/IP-PTX), and pressurized intraperitoneal aerosol chemotherapy (PIPAC)—have been investigated to improve local tumor control and survival outcomes. Methods: We systematically reviewed published studies evaluating HIPEC, NIPEC/IP-PTX, and PIPAC in PDAC, including adjuvant, cytoreductive, and palliative settings. Study characteristics, feasibility, perioperative outcomes, oncologic outcomes, and risk of bias were analyzed. Results: Across modalities, intraperitoneal treatment strategies demonstrated acceptable feasibility and safety profiles in appropriately selected patients. Adjuvant HIPEC following pancreatectomy showed reduced local–regional recurrence signals in limited cohorts. CRS + HIPEC among patients with isolated peritoneal metastases yielded encouraging multi-year survival in highly selected candidates achieving complete cytoreduction. NIPEC/IP-PTX demonstrated favorable ascites control, symptom relief, and potential conversion to resection in select patients. PIPAC was primarily used in unresectable, heavily pretreated, palliative peritoneal metastasis settings, with goals centered on disease stabilization, histologic regression, and symptom control rather than curative intent. Conclusions: Intraperitoneal chemotherapy strategies in PDAC appear feasible with signals of meaningful clinical benefit in select settings. While CRS + HIPEC may benefit carefully selected metastatic patients, NIPEC/IP-PTX and PIPAC hold value primarily in symptom control and disease stabilization. Larger prospective trials are needed to define patient selection, optimize treatment protocols, and clarify survival benefit.
背景：腹膜转移是胰腺导管腺癌（PDAC）的一种侵袭性疾病模式，传统上认为其生存期短且治疗选择有限。为改善局部肿瘤控制和生存结局，新兴的腹腔内化疗策略——包括腹腔热灌注化疗（HIPEC）、常温腹腔内紫杉醇化疗（NIPEC/IP-PTX）以及加压腹腔内气溶胶化疗（PIPAC）——已得到研究探索。 方法：我们系统回顾了已发表的评估HIPEC、NIPEC/IP-PTX和PIPAC在PDAC中应用的研究，涵盖辅助治疗、肿瘤细胞减灭术及姑息治疗等不同场景。分析了研究特征、可行性、围手术期结局、肿瘤学结局以及偏倚风险。 结果：在不同治疗模式中，腹腔内治疗策略在恰当选择的患者中显示出可接受的可行性和安全性。在有限队列中，胰腺切除术后辅助性HIPEC显示出局部-区域复发减少的迹象。对于孤立性腹膜转移患者，在实现完全肿瘤细胞减灭的高度筛选病例中，肿瘤细胞减灭术联合HIPEC显示出令人鼓舞的多年生存期。NIPEC/IP-PTX在特定患者中表现出良好的腹水控制、症状缓解以及潜在转化为可切除状态的潜力。PIPAC主要用于不可切除、经过多线治疗的姑息性腹膜转移场景，其目标侧重于疾病稳定、组织学缓解和症状控制，而非治愈目的。 结论：PDAC的腹腔内化疗策略具有可行性，并在特定场景中显示出有意义的临床获益信号。虽然肿瘤细胞减灭术联合HIPEC可能使精心筛选的转移患者获益，但NIPEC/IP-PTX和PIPAC的价值主要体现在症状控制和疾病稳定方面。需要更大规模的前瞻性试验来确定患者选择标准、优化治疗方案并明确生存获益。
肿瘤(癌症)患者之家