Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy
Prospective morbidity and mortality assessment of cytoreductive surgery plus perioperative intraperitoneal chemotherapy to treat peritoneal dissemination of appendiceal mucinous malignancy
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DOI：
10.1245/aso.2006.03.079
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发表时间：
2006-05-01
影响因子：
3.7
通讯作者：
Chang, D
中科院分区：
文献类型：
--
作者：
Sugarbaker, PH;Alderman, R;Chang, D
在大多数病人中，阑尾粘液性肿瘤在初次诊断时表现为腹膜播散。患者可能患有边界性肿瘤，表现为播散性腹膜粘液腺病或侵袭性恶性肿瘤，确定为腹膜粘液腺癌。1998年建立了一个数据库，前瞻性地评估了这组患者的发病率和死亡率。通过使用常见的毒性分级标准，对8个类别进行I至V级评分。IV级表示不良事件需要紧急和明确的干预：通常返回手术室或外科重症监护室。V级表示不良事件导致患者死亡。对这些腹膜恶性肿瘤患者进行的每一次细胞减灭术的不良事件进行了列表。有356例患者接受了腹膜切除术加术中腹腔内加热化疗的细胞减灭术。只有在我们机构接受这种联合治疗的患者才被纳入分析。总的30天或住院死亡率为2.0%。19%的手术伴有至少一次IV级不良事件，11.1%的患者返回手术室。最常见的IV级并发症是血液学（28%），其次是胃肠道（26%）。根据现代胃肠道癌症管理标准，这些患者的死亡率为2.0%，总体IV级发病率为19%，这是可以接受的。
Appendiceal mucinous neoplasms present, in most patients, with peritoneal dissemination at the time of initial diagnosis. Patients may have a borderline tumor showing disseminated peritoneal adenomucinosis or an aggressive malignancy identified as peritoneal mucinous adenocarcinoma. Patients with these diagnoses were treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy.A database was established in 1998 that prospectively evaluated the morbidity and mortality of this group of patients. By using common toxicity grading criteria, 8 categories were scored on a grade of I to V. Grade IV indicated that the adverse event required urgent and definitive intervention: often a return to the operating room or to the surgical intensive care unit. Grade V indicated that the adverse events resulted in the patient's death. Adverse events were tabulated for each cytoreduction performed in these appendiceal malignancy patients.There were 356 procedures in patients taken to the operating room who received cytoreductive surgery with peritonectomy procedures plus heated intraoperative intraperitoneal chemotherapy. Only patients who had this combined treatment at our institution were included in the analysis. The total 30-day or in-hospital mortality was 2.0%. Nineteen percent of procedures were accompanied by at least one grade IV adverse event, and 11.1% of patients returned to the operating room. The most common category of grade IV complications was hematological (28%), followed by gastrointestinal (26%).The mortality of 2.0% and the overall grade IV morbidity of 19% in these patients may be acceptable in light of modern standards for the management of gastrointestinal cancer.