La chimiothérapie hyperthermique intrapéritonéale : Un nouvel espoir pour les patients atteints de carcinose péritonéale Quelle prise en charge kinésithérapique proposer ?
Julie Weyrech, Camille Beauvair
Kinésithér Scient 2015,0561:23-29 - 10/01/2015
La carcinose péritonéale (CP) a longtemps été considérée comme le stade terminal des cancers viscéraux¬: «¬On ouvre et on referme¬». La maladie s'avérait souvent non chimiosensible et, même en cas de chirurgie d'exérèse, la récidive était systématique et rapide. Le pronostic de cette maladie était alors péjoratif, la médiane de survie restant inférieure à 8 mois. Une hypothèse de traitement a été proposée en 1988 par un chirurgien américain, Paul Sugarbaker¬ : associer une chimiothérapie hyperthermique intrapéritonéale (CHIP) à une chirurgie de cytoréduction. En France, quelques équipes ont commencé dès les années 1990 à expérimenter cette technique et ont publié des résultats très encourageants. Depuis 2006, le service de chirurgie digestive de l'hôpital Lariboisière fait partie des centres experts. En 2012, cinquante patients ont bénéficié d'une CHIP. En période postopératoire, le rôle de la kinésithérapie devient prépondérant. La mécanique ventilatoire du malade et son autonomie motrice sont perturbées. Il s'agit alors de lutter contre les complications respiratoires et les troubles du décubitus. Depuis 2011, l'utilisation d'une auto-analgésie postopératoire par voie péridurale et la mise en place d'une consultation de kinésithérapie préopératoire vise à améliorer la prise en charge multimodale de ces patients.
Peritoneal carcinomatosis was considered the terminal stage for visceral cancer in the past. We open and we close. The disease is often not sensitive to chemotherapy and even when there is surgical excision the recurrence is often systematic and rapid. The prognosis is poor, the median survival being less than 8 months. A treatment hypothesis was put forward in 1988 by an American surgeon, Paul Sugarbaker : to associate hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery. In France several teams began to experiment in the 1990s and some encouraging results. Since 2006 the digestive surgery department at the Lariboisiere hospital is considered to be a specialised centre. In 2012, ¬ fifty patients were treated with HIPEC. The role of the physiotherapist is predominantly in the post-operative period as the patient is mechanical ventilated and their motor autonomy is disturbed. One must ¬ fight against respiratory complications and problems related to bed rest. Since 2011, the utilisation of an auto analgesia post-op via an epidural catheter as well as a pre-operative physiotherapy consultation aims at improving the management of these patients.
Peritoneal carcinomatosis was considered the terminal stage for visceral cancer in the past. We open and we close. The disease is often not sensitive to chemotherapy and even when there is surgical excision the recurrence is often systematic and rapid. The prognosis is poor, the median survival being less than 8 months. A treatment hypothesis was put forward in 1988 by an American surgeon, Paul Sugarbaker : to associate hyperthermic intraperitoneal chemotherapy (HIPEC) with cytoreductive surgery. In France several teams began to experiment in the 1990s and some encouraging results. Since 2006 the digestive surgery department at the Lariboisiere hospital is considered to be a specialised centre. In 2012, ¬ fifty patients were treated with HIPEC. The role of the physiotherapist is predominantly in the post-operative period as the patient is mechanical ventilated and their motor autonomy is disturbed. One must ¬ fight against respiratory complications and problems related to bed rest. Since 2011, the utilisation of an auto analgesia post-op via an epidural catheter as well as a pre-operative physiotherapy consultation aims at improving the management of these patients.
