Bartlett Edmund K, Choudhury Rashikh A, Roses Robert E, Fraker Douglas L, Kelz Rachel R, Karakousis Giorgos C
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA,
Ann Surg Oncol. 2015 May;22(5):1664-72. doi: 10.1245/s10434-014-3975-0. Epub 2014 Aug 15.
In the absence of large randomized trials, the independent contribution of intraperitoneal chemotherapy (IPC) to morbidity and mortality (M+M) from cytoreductive surgery remains uncertain. In a multi-institutional cohort of colorectal surgery patients, we examined the association between M+M and the use of IPC.
Patients undergoing an open colorectal resection for cancer with and without administration of IPC were identified using the American College of Surgeons National Surgical Quality Improvement Program database (2005-2012). Multivariate logistic regression identified factors associated with 30-day M+M. Using a propensity score matching method, patients undergoing IPC were matched 1:3 to non-IPC patients. M+M within the matched cohort was compared using the χ (2) test.
Of the 33,912 patients identified, 188 had concurrent IPC. The M+M rates were 41 and 30 % with and without IPC, respectively (p = 0.002). In multivariate analysis, IPC was not associated with M+M (odds ratio 0.92; p = 0.62). Using a propensity score match to control for patient and operative factors, patients who received IPC (n = 188) were matched to patients who did not receive IPC (n = 365). The M+M rates in the matched cohort did not significantly differ (41 % with IPC and 45 % without IPC; p = 0.34). Similarly, mortality (1.1 vs. 2.5 %; p = 0.26) and length of stay (12 vs. 11 days; p = 0.27) were not affected by IPC status.
After controlling for patient and operative factors, IPC was not associated with increased M+M following colorectal resection. The high morbidity observed in patients receiving IPC appears to be driven by operative factors other than the use of IPC.
在缺乏大型随机试验的情况下，腹腔内化疗（IPC）对减瘤手术发病率和死亡率（M+M）的独立影响仍不确定。在一个多机构的结直肠手术患者队列中，我们研究了M+M与IPC使用之间的关联。
利用美国外科医师学会国家外科质量改进计划数据库（2005 - 2012年）识别接受开放性结直肠癌切除术且接受或未接受IPC的患者。多变量逻辑回归确定与30天M+M相关的因素。使用倾向评分匹配方法，将接受IPC的患者与未接受IPC的患者按1:3进行匹配。使用χ²检验比较匹配队列中的M+M情况。
在识别出的33912例患者中，188例同时接受了IPC。接受IPC和未接受IPC的患者M+M率分别为41%和30%（p = 0.002）。在多变量分析中，IPC与M+M无关（优势比0.92；p = 0.62）。使用倾向评分匹配来控制患者和手术因素，接受IPC的患者（n = 188）与未接受IPC的患者（n = 365）进行匹配。匹配队列中的M+M率无显著差异（接受IPC的为41%，未接受IPC的为45%；p = 0.34）。同样，死亡率（1.1%对2.5%；p = 0.26）和住院时间（12天对11天；p = 0.27）不受IPC状态的影响。
在控制患者和手术因素后，IPC与结直肠切除术后M+M增加无关。接受IPC的患者中观察到的高发病率似乎是由IPC使用以外的手术因素驱动的。
