Hadi Reema, Saunders Vanessa, Utkina Olga, Clingan Philip, Kam Peter, Links Matthew, Morris David L
University of New South Wales, Department of Surgery, Sydney, New South Wales, Australia.
ANZ J Surg. 2006 Mar;76(3):156-61. doi: 10.1111/j.1445-2197.2006.03579.x.
Peritoneal dissemination of malignancy is usually considered incurable. The purpose of the present study was to evaluate the efficacy of intraperitoneal chemohyperthermia and cytoreductive surgery.
The present article is a retrospective review of prospectively recorded data in 60 patients who underwent 71 peritonectomy procedures between January 1996 and May 2004. Hospital records, a database and department notes were studied. Conditions treated were pseudomyxoma peritoneii (PMP) and appendiceal cancer (23), mesothelioma (7), colorectal cancer (CRC, 15), ovarian cancer (6) and other forms of malignancy (9). Following cytoreductive surgery, early postoperative intraperitoneal chemotherapy (EPIC) was given in 47 procedures, five with added i.v. mitomycin C. In 34 procedures, heated intraperitoneal chemotherapy (HIPEC) was administered. A policy change was made from intravenous to intraperitoneal mitomycin C chemotherapy in December 2001. Peritoneal cancer index (PCI) was calculated for all procedures.
Of the procedures, 23 had PCI < or = 10, 37 had PCI of 11-20, and 11 had PCI > 20. The median operation time was 9 h. Blood units transfused and length of hospital stay have declined. Mortality was 4/60 patients (6.7%), caused by pancytopenia and sepsis. Morbidity occurred in 28/71 procedures. The 3-year survival rate for the HIPEC group was 71% compared with 28% for the no HIPEC group. In the complete excision group, the 3-year survival rate was 52% compared with 13% for the incomplete excision group. The 3-year survival rate for PMP and appendiceal cancer was 74%. The 2-year survival rate for ovarian cancer was 67%, mesothelioma 57%, and CRC 50%, respectively.
Morbidity is significantly associated with duration of surgery and units of blood transfused. Our findings are consistent with the international experience in patients treated with combined peritonectomy and HIPEC.
恶性肿瘤的腹膜播散通常被认为无法治愈。本研究的目的是评估腹腔内热化疗和肿瘤细胞减灭术的疗效。
本文是一项对1996年1月至2004年5月期间接受71例腹膜切除术的60例患者的前瞻性记录数据的回顾性研究。研究了医院记录、数据库和科室记录。治疗的疾病包括腹膜假黏液瘤（PMP）和阑尾癌（23例）、间皮瘤（7例）、结直肠癌（CRC，15例）、卵巢癌（6例）和其他恶性肿瘤形式（9例）。在肿瘤细胞减灭术后，47例手术给予了术后早期腹腔内化疗（EPIC），5例加用静脉注射丝裂霉素C。在34例手术中，给予了热腹腔内化疗（HIPEC）。2001年12月，化疗方案从静脉注射丝裂霉素C改为腹腔内注射。计算了所有手术的腹膜癌指数（PCI）。
在这些手术中，23例PCI≤10，37例PCI为11 - 20，11例PCI>20。中位手术时间为9小时。输血单位数和住院时间有所下降。死亡率为4/60例患者（6.7%），原因是全血细胞减少和败血症。28/71例手术发生了并发症。HIPEC组的3年生存率为71%，而未进行HIPEC组为28%。在完全切除组中，3年生存率为52%，不完全切除组为13%。PMP和阑尾癌的3年生存率为74%。卵巢癌、间皮瘤和CRC的2年生存率分别为67%、57%和50%。
并发症与手术时间和输血量显著相关。我们的研究结果与国际上联合腹膜切除术和HIPEC治疗患者的经验一致。
