Hamilton Trevor D, Taylor Emily L, Cannell Amanda J, McCart J Andrea, Govindarajan Anand
Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
Division of General Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Ann Surg Oncol. 2016 Sep;23(9):2946-52. doi: 10.1245/s10434-016-5231-2. Epub 2016 Apr 19.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an effective treatment for selected patients with peritoneal surface malignancies (PSM). Although it can have significant morbidity, perioperative mortality is low. Little is known about whether major complications after CRS/HIPEC have a lasting impact on patients' quality of life (QOL).
We retrospectively reviewed data from a prospectively collected database on patients treated with CRS/HIPEC for PSM (2011-2014). Patients with CRS/HIPEC and 6-month QOL evaluation were included. Major perioperative complications (Clavien-Dindo grade 3/4) were the primary independent variable. QOL was evaluated using the validated EORTC QLQ-C30 score. The primary outcome was 6-month global health score. Secondary outcomes were individual functional and symptom domains.
Forty-two patients were analyzed. Median age was 57.5; 64 % were female. Origin of PSM was appendix (55 %), colorectal (38 %), mesothelioma (5 %), and small bowel (2 %). Fourteen patients (33 %) had major (grade 3/4) complications. Median length of stay was 16 days; patients experiencing major complications had significantly increased length of stay (35.5 vs. 13 days, p < 0.01). Major complications included intra-abdominal abscess (9.5 %), bleeding (9.5 %), symptomatic pleural effusion (7.1 %), anastomotic leaks (7.1 %), and renal failure (2.4 %). The average global health score at 6 months was 68.1. The worst-rated symptom scores at 6 months were diarrhea (39.8) and fatigue (35.4). There were no significant differences in 6-month QOL scores between patients with and without major complications, globally or in specific domains.
Although major complications are common after CRS/HIPEC, QOL at 6 months recovers and is similar to those without major complications.
细胞减灭术（CRS）及腹腔热灌注化疗（HIPEC）是治疗特定腹膜表面恶性肿瘤（PSM）患者的有效方法。尽管该治疗可能导致显著的发病率，但围手术期死亡率较低。关于CRS/HIPEC术后的主要并发症是否会对患者的生活质量（QOL）产生持久影响，目前知之甚少。
我们回顾性分析了一个前瞻性收集的数据库中2011年至2014年接受CRS/HIPEC治疗的PSM患者的数据。纳入接受CRS/HIPEC治疗且有6个月生活质量评估的患者。围手术期主要并发症（Clavien-Dindo 3/4级）是主要的独立变量。使用经过验证的欧洲癌症研究与治疗组织（EORTC）QLQ-C30评分评估生活质量。主要结局是6个月时的总体健康评分。次要结局是各个功能和症状领域。
分析了42例患者。中位年龄为57.5岁；64%为女性。PSM的起源为阑尾（55%）、结直肠（38%）、间皮瘤（5%）和小肠（2%）。14例患者（33%）发生主要（3/4级）并发症。中位住院时间为16天；发生主要并发症的患者住院时间显著延长（35.5天对13天，p<0.01）。主要并发症包括腹腔内脓肿（9.5%）、出血（9.5%）、有症状的胸腔积液（7.1%）、吻合口漏（7.1%）和肾衰竭（2.4%）。6个月时的平均总体健康评分为68.1。6个月时评分最差的症状是腹泻（39.8）和疲劳（35.4）。有主要并发症和无主要并发症的患者在6个月时的生活质量评分在总体或特定领域均无显著差异。
尽管CRS/HIPEC术后主要并发症常见，但6个月时的生活质量得以恢复，且与无主要并发症的患者相似。
