肥胖与腹膜表面疾病：阑尾和结肠原发性肿瘤行细胞减灭术联合腹腔热灌注化疗的结局。
Obesity and peritoneal surface disease: outcomes after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for appendiceal and colon primary tumors.
机构信息
Department of General Surgery, Wake Forest University, Winston-Salem, NC, USA,
出版信息
Ann Surg Oncol. 2013 Nov;20(12):3899-904. doi: 10.1245/s10434-013-3087-2. Epub 2013 Jun 26.
BACKGROUND
It is estimated that 37% of the U.S. population is obese. It is unknown how obesity influences the operative and survival outcomes of cytoreductive surgery (CRS)/hyperthermic intraperitoneal chemotherapy (HIPEC) procedures.
METHODS
A retrospective analysis of a prospective database of 1,000 procedures was performed. Type of malignancy, performance status, resection status, hospital and intensive care unit stay, comorbidities, morbidity, mortality, and survival were reviewed.
RESULTS
A total of 246 patients with body mass index (BMI) of >30 kg/m(2) underwent 272 CRS/HIPEC procedures. Ninety-five (38.6%) were severely obese (BMI > 35 kg/m(2)). A total of 135 (49.6%) procedures were performed for appendiceal and 60 (22.1%) for colon cancer. Median follow-up was 52 months. Both major and minor morbidity were similar for obese and non-obese patients. The 30-day mortality rates for obese and non-obese patients were 1.5 and 2.5%, respectively. Median intensive care unit and hospital stay were 1 and 9 days, regardless of BMI. The 30-day readmission rate was similar between obese and non-obese patients (24.8 vs. 19.4%, p = 0.11). Median survival for low-grade appendiceal cancer (LGA) was 76 months for obese patients and 107 months for non-obese patients (p = 0.32). Survival was worse for severely obese patients (median survival 54 months) versus non-obese patients with LGA (p = 0.04). Survival was similar for obese and non-obese patients with peritoneal surface disease (PSD) from colon cancer or high-grade appendiceal cancer.
CONCLUSIONS
Obesity does not influence postoperative morbidity or mortality of patients with PSD, regardless of primary tumor. Severe obesity is associated with decreased long-term survival only in patients with LGA primary disease; however, application of CRS/HIPEC still offers meaningful prolongation of life. Obesity should not be considered a contraindication for CRS/HIPEC procedures.
背景
据估计，美国有 37%的人口肥胖。肥胖如何影响细胞减灭术（CRS）/腹腔热灌注化疗（HIPEC）手术的手术和生存结果尚不清楚。
方法
对 1000 例前瞻性数据库进行回顾性分析。回顾分析了恶性肿瘤类型、身体状况、切除情况、住院和重症监护病房停留时间、合并症、发病率、死亡率和生存率。
结果
共有 246 例 BMI（体重指数）>30kg/m2的患者接受了 272 例 CRS/HIPEC 手术。其中 95 例（38.6%）为严重肥胖（BMI>35kg/m2）。135 例（49.6%）手术为阑尾癌，60 例（22.1%）为结肠癌。中位随访时间为 52 个月。肥胖和非肥胖患者的主要和次要发病率相似。肥胖和非肥胖患者的 30 天死亡率分别为 1.5%和 2.5%。无论 BMI 如何，重症监护病房和医院的中位住院时间均为 1 天和 9 天。肥胖和非肥胖患者的 30 天再入院率相似（24.8%vs.19.4%，p=0.11）。低级别阑尾癌（LGA）肥胖患者的中位生存时间为 76 个月，非肥胖患者为 107 个月（p=0.32）。与非肥胖的 LGA 患者相比，重度肥胖患者的中位生存时间更差（54 个月）（p=0.04）。肥胖和非肥胖的结直肠癌或高级别阑尾癌腹膜表面疾病（PSD）患者的生存情况相似。
结论
肥胖并不影响 PSD 患者的术后发病率或死亡率，与原发肿瘤无关。严重肥胖仅与 LGA 原发疾病患者的长期生存下降相关；然而，CRS/HIPEC 的应用仍然可以显著延长患者的生命。肥胖不应被视为 CRS/HIPEC 手术的禁忌症。
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