Simkens Geert A, Verwaal Vic J, Lemmens Valery E, Rutten Harm J, de Hingh Ignace H
Department of Surgical Oncology, Catharina Hospital, Eindhoven, The Netherlands Department of Surgery, Aarhus University Hospital, Aarhus, Denmark Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Medicine (Baltimore). 2016 Oct;95(41):e5111. doi: 10.1097/MD.0000000000005111.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an extensive procedure with considerable morbidity. Since only few hospitals perform CRS + HIPEC, this might lead to confounded outcomes between hospitals when audited. This study aims to compare outcomes between peritoneally metastasized (PM) colon cancer patients treated with CRS + HIPEC and patients undergoing conventional colon surgery. Furthermore, the impact of CRS + HIPEC on the risk of postoperative complications will be assessed, probably leading to better insight into how to report on postoperative outcomes in this distinct group of patients undergoing extensive colon surgery.All patients with primary colon cancer who underwent segmental colon resection in a tertiary referral hospital between 2011 and 2014 were included in this prospective cohort study. Outcome after surgery was compared between patients who underwent additional CRS + HIPEC treatment or conventional surgery.Consequently, 371 patients underwent surgery, of which 43 (12%) underwent CRS + HIPEC. These patients were younger and healthier than patients undergoing conventional surgery. Tumor characteristics were less favorable and surgery was more extensive in CRS + HIPEC patients. The morbidity rate was also higher in CRS + HIPEC patients (70% vs 41%; P < 0.001). CRS + HIPEC was an independent predictor of postoperative complications (odds ratio 6.4), but was not associated with more severe postoperative complications or higher treatment-related mortality.Although patients with colonic PM undergoing CRS + HIPEC treatment were younger and healthier, the postoperative outcome was worse. This is most probably due to less favorable tumor characteristics and more extensive surgery. Nevertheless, CRS + HIPEC treatment was not associated with severe complications or increased treatment-related mortality. These results stress the need for adequate case-mix correction in colorectal surgery audits.
细胞减灭术（CRS）和腹腔内热灌注化疗（HIPEC）是一种具有较高发病率的广泛手术。由于只有少数医院开展CRS+HIPEC，在接受审核时，这可能导致不同医院之间的结果混淆。本研究旨在比较接受CRS+HIPEC治疗的腹膜转移（PM）结肠癌患者与接受传统结肠手术患者的治疗结果。此外，还将评估CRS+HIPEC对术后并发症风险的影响，这可能有助于更好地了解如何报告这一接受广泛结肠手术的特殊患者群体的术后结果。
2011年至2014年间在一家三级转诊医院接受节段性结肠切除术的所有原发性结肠癌患者均纳入本前瞻性队列研究。对接受额外CRS+HIPEC治疗或传统手术的患者术后结果进行比较。
结果，371例患者接受了手术，其中43例（12%）接受了CRS+HIPEC。这些患者比接受传统手术的患者更年轻、更健康。CRS+HIPEC患者的肿瘤特征较差，手术范围更广。CRS+HIPEC患者的发病率也更高（70%对41%；P<0.001）。CRS+HIPEC是术后并发症的独立预测因素（比值比6.4），但与更严重的术后并发症或更高的治疗相关死亡率无关。
尽管接受CRS+HIPEC治疗的结肠PM患者更年轻、更健康，但其术后结果更差。这很可能是由于肿瘤特征较差和手术范围更广。然而，CRS+HIPEC治疗与严重并发症或治疗相关死亡率增加无关。这些结果强调了结直肠癌手术审核中进行充分病例组合校正的必要性。
