Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: Experience with 501 procedures
Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: Experience with 501 procedures
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DOI：
10.1016/j.jamcollsurg.2006.12.048
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发表时间：
2007-05-01
影响因子：
5.2
通讯作者：
Shen, Perry
中科院分区：
文献类型：
--
作者：
Levine, Edward A.;Stewart, John H., IV;Shen, Perry
背景：腹部恶性肿瘤腹膜播散（PSD）的临床过程以肠梗阻和死亡为标志。我们一直使用积极的细胞减灭术与腹腔热化疗（lPHC）治疗PSD。这篇文章的目的是回顾我们的经验与lPHC.Study设计：一个前瞻性的数据库，接受IPHC的患者自1991年以来一直保持。对患者进行统一评估和治疗。将人口统计学、体能状态、切除状态、原发部位和经验四分位数与结局进行比较。结果：共460例患者接受了501例IPHC手术。平均年龄为53.0岁，50.4%为女性。30天死亡率为4.8%，并发症发生率为43%，中位住院时间为9天。中位随访时间为55.4个月，中位生存期为22.2个月，5年生存率为27.8%。与生存率提高相关的因素包括体能状态（p = 0.0001）、原发肿瘤（p = 0.0001）、切除状态（p = 0.0001）、并发症（p = 0.002）、既往IPHC（p = 0.006）和经验四分位数（p = 0.031）。在多变量分析中，原发肿瘤部位、体能状态、切除状态和并发症的发生（p < 0.001）预测了预后。结论：我们的经验表明，术前更好预后的标准包括原发肿瘤部位和体能状态。切除的完整性和术后并发症的发生也是至关重要的，随着时间的推移，结果有所改善。肿瘤细胞减灭术和IPHC代表了与历史系列和最佳可用的全身治疗相比结局的实质性改善。对于接受该手术的选定患者，长期生存是可能的。
BACKGROUND: Peritoneal dissemination of abdominal malignancy (PSD) has a clinical course marked by bowel obstruction and death. We have been using aggressive cytoreductive surgery with intraperitoneal hyperthermic chemotherapy (lPHC) to treat PSD. The purpose of this article was to review our experience with lPHC.STUDY DESIGN: A prospective database of patients undergoing IPHC has been maintained since 1991. Patients were uniformly evaluated and treated. Demographics, performance status, resection status, primary site, and experience quartile were compared with outcomes. Univariate and multivariate analyses were performed.RESULTS: A total of 460 patients underwent 501 IPHC procedures. Average age was 53.0 years, and 50.4% were women. The 30-day mortality rate was 4.8%, the complication rate was 43%, and median hospital stay was 9 days. Median followup was 55.4 months, median survival was 22.2 months, and 5-year survival rate was 27.8%. Factors correlating with improved survival were performance status (p = 0.0001), primary tumor (p = 0.0001), resection status (p = 0.0001), complications (p = 0.002), previous IPHC (p = 0.006), and experience quartile (p = 0.031). On multivariate analysis, primary tumor site, performance status, resection status, and development of complications (p < 0.001) predicted outcomes.CONCLUSIONS: Our experience demonstrated that preoperative criteria for better outcomes include primary tumor site and performance status. Completeness of resection and development of postoperative complications are also crucial, and outcomes have improved over time. Cytoreductive surgery and IPHC represent substantial improvements in outcomes compared with historic series and best-available systemic therapy. Longterm survival is possible for selected patients who undergo the procedure.