Department of Surgery, National Cancer Institute, Milan, Italy.
Ann Surg. 2012 Aug;256(2):334-41. doi: 10.1097/SLA.0b013e31825704e3.
To assess the influence of parietal and visceral peritonectomy procedures on moderate/severe morbidity in patients undergoing surgical cytoreducion and hyperthermic intraperitoneal chemotherapy (HIPEC) and to identify subgroups of patients at highest operative risk.
Cytoreducion with HIPEC is an effective but potentially morbid treatment option for peritoneal surface malignancies. Although complication rates have recently decreased with increasing experience, risk-factors for adverse operative outcome are still poorly understood.
A prospective database of 426 combined procedures was reviewed. Multivariate analysis tested the correlation between major morbidity and 6 peritonectomies (greater and lesser omentectomy, pelvic, parietal anterior, left and right diaphragmatic peritonectomy), 14 visceral resections, 5 other operative factors, and 12 clinical variables. The extent of peritoneal involvement was quantified by peritoneal cancer index (PCI).
Mortality and major morbidity were 2.6% and 28.2%. PCI, number of visceral resections, poor performance status, and cisplatin dose more than 240 mg independently correlated to morbidity. The type and number of parietal peritonectomies and the type of visceral resections did not correlated to complications. Major morbidity rate was 65.7% in 35 (8.2%) patients with at least 2 of the following factors: PCI greater than 30, more than 5 visceral resections, poor performance status. Morbidity was 100% in 9 patients presenting all the risk factors.
Acceptable morbidity and low mortality may be achieved in high-volume centers. Operative outcome is mainly affected by a complex interplay of tumor, patient, and treatment-related factors. Preoperative and early intraoperative assessment of operative risk may identify a subset of patients unlikely to tolerate aggressive management.
评估壁层和内脏腹膜切除术对接受手术减瘤和腹腔内热灌注化疗（HIPEC）的患者发生中重度发病率的影响，并确定手术风险最高的患者亚组。
HIPEC 联合细胞减灭术是治疗腹膜表面恶性肿瘤的一种有效但潜在高风险的治疗选择。尽管随着经验的增加，并发症发生率最近有所下降，但不良手术结果的风险因素仍知之甚少。
回顾性分析了 426 例联合手术的前瞻性数据库。多变量分析测试了主要发病率与 6 种腹膜切除术（大网膜切除术、小网膜切除术、骨盆腹膜切除术、壁层前腹膜切除术、左膈腹膜切除术和右膈腹膜切除术）、14 种内脏切除术、5 种其他手术因素和 12 种临床变量之间的相关性。腹膜癌症指数（PCI）量化了腹膜受累的程度。
死亡率和主要发病率分别为 2.6%和 28.2%。PCI、内脏切除术的数量、较差的功能状态和顺铂剂量超过 240mg 与发病率独立相关。壁层腹膜切除术的类型和数量以及内脏切除术的类型与并发症无关。在至少有以下 2 个因素的 35 例（8.2%）患者中，主要发病率为 65.7%：PCI>30、超过 5 种内脏切除术、功能状态差。在 9 例患者中，所有危险因素均存在，发病率为 100%。
在高容量中心，可实现可接受的发病率和低死亡率。手术结果主要受肿瘤、患者和治疗相关因素的复杂相互作用影响。术前和早期手术评估手术风险可能会确定一组不太可能耐受积极治疗的患者。
