Department of Surgery, University of California, Irvine, School of Medicine, Orange.
Department of Statistics, University of California, Irvine.
JAMA Surg. 2014 Feb;149(2):170-5. doi: 10.1001/jamasurg.2013.3640.
Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC.
To determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011.
Thirty-day mortality and morbidity.
Of the cancers identified among the 694 sampled cases, 14% of patients had appendiceal cancer, 11% had primary peritoneal cancer, and 8% had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70% of patients. The average operative time was 7.6 hours, with 15% of patients requiring intraoperative transfusions. Postoperative bleeding (17%), septic shock (16%), pulmonary complications (15%), and organ-space infections (9%) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11%. The rate of reoperation was 10%, with an overall mortality rate of 2%.
American College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.
高热腹腔内化疗（HIPEC）和细胞减灭术已被证明对患有腹膜癌病的选定患者有益。然而，这些手术与高发病率和死亡率相关。目前，可用于调查 HIPEC 结果的可用数据主要限于单中心研究。迄今为止，很少有大规模研究调查 HIPEC 的术后结果。
在美国外科医师学会国家手术质量改进计划中心，确定细胞减灭术-HIPEC 治疗转移性和原发性腹膜癌的 30 天发病率和死亡率。
设计、地点和参与者：对原发性和转移性腹膜癌诊断中进行的 HIPEC 病例进行了回顾性审查。采样了细胞减灭性外科手术，并确定了疾病过程。从美国外科医师学会国家手术质量改进计划（2005-2011 年）中回顾了患者人口统计学，术中发生情况和术后并发症。
30 天死亡率和发病率。
在所确定的 694 例样本癌症中，14％的患者患有阑尾癌，11％的患者患有原发性腹膜癌，8％的患者患有结直肠癌。70％的患者的美国麻醉师协会分类为 3 级。平均手术时间为 7.6 小时，有 15％的患者需要术中输血。术后出血（17％），感染性休克（16％），肺部并发症（15％）和器官空间感染（9％）是最常见的术后并发症。平均住院时间为 13 天，30 天再入院率为 11％。再手术率为 10％，总死亡率为 2％。
进行 HIPEC 的美国外科医师学会国家手术质量改进计划医院具有可接受的发病率和死亡率。
