Piso Pompiliu, Slowik Przemyslaw, Popp Felix, Dahlke Marc Hendrik, Glockzin Gabriel, Schlitt Hans Juergen
Department of Surgery, University Medical Center Regensburg, Regensburg, Germany.
Ann Surg Oncol. 2009 Aug;16(8):2188-94. doi: 10.1245/s10434-009-0478-5. Epub 2009 May 2.
Cytoreductive surgery (CRS) including gastric resection combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can improve the prognosis of selected patients with peritoneal surface malignancies. Perioperative morbidity of this aggressive treatment strategy is high; however, overall mortality can be low in specialized centers. The aim of this study was to assess the safety of gastric resections with anastomosis during CRS and HIPEC.
Between 2005 and 2008, 204 patients underwent CRS and HIPEC at our tertiary referral centre. Of these, 37 procedures (male/female 24/13, median age 55 years) included gastric resections. The clinical data of all patients were introduced into a database and analyzed with respect to the morbidity associated with the gastric resections.
Of all patients included, 16 had pseudomyxoma peritonei, 11 gastric carcinoma, 4 ovarian carcinoma, 3 malignant peritoneal mesothelioma, and 3 colon carcinoma. Twenty-seven patients had previous surgery (n = 22) and/or systemic chemotherapy (n = 18). Fifteen total gastrectomies, 3 subtotal gastrectomies, 12 distal gastrectomies, and 7 gastric wedge resections were performed during CRS. The overall postoperative morbidity was 45%; main surgical complications were pancreatitis (n = 6), abdominal abscess (n = 4), bile leakage (n = 2), and digestive fistula (leakage of ileorectostomy and small bowel perforation) (n = 2). However, no complications occurred at the site of the esophageal anastomosis (n = 15), gastric anastomosis (n = 15) or gastric suture (n = 7). No patient died postoperatively during the hospitalization period.
CRS in combination with HIPEC is associated with high postoperative morbidity; however, anastomosis following total or subtotal gastrectomy is safe in experienced centers. No leakages related to gastric resections occurred in this high-risk patient group.
细胞减灭术（CRS），包括胃切除术联合腹腔热灌注化疗（HIPEC），可改善部分腹膜表面恶性肿瘤患者的预后。这种积极的治疗策略围手术期发病率较高；然而，在专业中心总体死亡率可能较低。本研究的目的是评估CRS及HIPEC期间胃切除吻合术的安全性。
2005年至2008年期间，204例患者在我们的三级转诊中心接受了CRS及HIPEC。其中，37例手术（男性/女性24/13，中位年龄55岁）包括胃切除术。将所有患者的临床数据录入数据库，并分析与胃切除术相关的发病率。
纳入的所有患者中，16例患有腹膜假黏液瘤，11例患有胃癌，4例患有卵巢癌，3例患有恶性腹膜间皮瘤，3例患有结肠癌。27例患者曾接受过手术（n = 22）和/或全身化疗（n = 18）。CRS期间进行了15例全胃切除术、3例次全胃切除术、1例2远端胃切除术和7例胃楔形切除术。总体术后发病率为45%；主要手术并发症为胰腺炎（n = 6）、腹腔脓肿（n = 4）、胆漏（n = 2）和消化瘘（回直肠吻合口漏和小肠穿孔）（n = 2）。然而，食管吻合口（n = 15）、胃吻合口（n = 15）或胃缝合处（n = 7）均未发生并发症。住院期间无患者术后死亡。
CRS联合HIPEC术后发病率较高；然而，在经验丰富的中心，全胃或次全胃切除术后的吻合术是安全的。在这个高危患者群体中，未发生与胃切除术相关的渗漏。
