Downs-Canner Stephanie, Ding Ying, Magge Deepa R, Jones Heather, Ramalingam Lekshmi, Zureikat Amer, Holtzman Matthew, Ahrendt Steven, Pingpank James, Zeh Herbert J, Bartlett David L, Choudry Haroon A
Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA,
Ann Surg Oncol. 2015 May;22(5):1651-7. doi: 10.1245/s10434-014-4186-4. Epub 2014 Oct 28.
Postoperative pancreatic fistulas (POPFs) are potentially morbid complications that often require therapeutic interventions. Distal pancreatectomy performed during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemoperfusion (HIPEC) puts patients at risk for POPF. The authors hypothesized that POPFs are more severe after CRS/HIPEC than after pancreatectomy alone.
Clinicopathologic and perioperative details, including POPF by International Study Group of Pancreatic Fistula criteria (ISGPF), and oncologic outcomes for patients undergoing distal pancreatectomy during CRS/HIPEC for peritoneal carcinomatosis of appendiceal (n = 31) or colorectal (n = 23) origin (HIPEC group) were compared with those for patients undergoing minimally invasive or open distal pancreatectomy without HIPEC (n = 66) for locally resectable pancreatic adenocarcinoma (non-HIPEC group).
The incidence of POPF was similar between the HIPEC and non-HIPEC groups (26 %). The severity of POPF according to the ISGPF criteria was significantly worse in the HIPEC group. The HIPEC patients had 13 grade B fistulas and 1 grade C fistula compared with 12 grade A fistulas and 4 grade B fistulas in the non-HIPEC group. The HIPEC patients with POPF did not differ in the extent of their CRS, peritoneal cancer index, length of hospital stay, or other postoperative complications from the the HIPEC patients without POPF. The HIPEC patients with colorectal carcinomatosis who experienced POPF had higher disease recurrence in the first year after CRS/HIPEC than those without POPF.
The findings showed that POPFs are more severe when distal pancreatectomy is combined with CRS/HIPEC. Moreover, selective use of distal pancreatectomy is important during CRS/HIPEC because POPFs may increase early disease recurrence for patients with colorectal carcinomatosis.
术后胰瘘（POPF）是具有潜在危害性的并发症，常需进行治疗干预。在减瘤手术（CRS）及术中热灌注化疗（HIPEC）期间实施的胰体尾切除术会使患者面临发生POPF的风险。作者推测，与单纯胰体尾切除术后相比，CRS/HIPEC术后的POPF更为严重。
将接受CRS/HIPEC治疗阑尾来源（n = 31）或结直肠来源（n = 23）的腹膜癌患者进行胰体尾切除的临床病理及围手术期详细资料（包括按照国际胰瘘研究组标准[ISGPF]诊断的POPF）及肿瘤学结局，与接受微创或开放胰体尾切除术且未行HIPEC的局部可切除胰腺腺癌患者（n = 66）（非HIPEC组）进行比较。
HIPEC组和非HIPEC组的POPF发生率相似（26%）。根据ISGPF标准，HIPEC组的POPF严重程度明显更差。HIPEC组患者有13例B级瘘和1例C级瘘，而非HIPEC组有12例A级瘘和4例B级瘘。发生POPF的HIPEC患者在CRS范围、腹膜癌指数、住院时间或其他术后并发症方面与未发生POPF的HIPEC患者并无差异。发生POPF的结直肠癌腹膜转移HIPEC患者在CRS/HIPEC术后第一年的疾病复发率高于未发生POPF的患者。
研究结果表明，胰体尾切除术联合CRS/HIPEC时，POPF更为严重。此外，在CRS/HIPEC期间选择性使用胰体尾切除术很重要，因为POPF可能会增加结直肠癌腹膜转移患者的早期疾病复发率。
