Somashekhar S P, Prasanna G, Jaka Rajshekhar, Rauthan Amit, Murthy H S, Karanth Sunil
Department of Surgical Oncology and Robotic Surgery, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru 560017, Karnataka, India.
Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospital, 98 HAL Airport Road, Bengaluru 560017, Karnataka, India.
Natl Med J India. 2016 Sep-Oct;29(5):262-266.
Cytoreductive surgery followed by hyper- thermic intraperitoneal chemotherapy (HIPEC) has shown better oncological outcomes in peritoneal surface malignancies (PSM). We assessed the feasibility and perioperative outcomes of this procedure in Indian patients.
In this prospective observational study from February 2013 to April 2015, we included 56 patients (41 females, 73.2%) with PSM. They had a good performance status, were either treatment-naïve or previously treated by surgery and systemic chemotherapy. They underwent cytoreductive surgery followed by HIPEC using a hyperthermia pump, with the temperature at 42 °C for 30-90 minutes. The chemotherapy regimen was based on the primary malignancy. Perioperative outcome data were collected and analysed. We also analysed the short-term oncological outcomes.
Our patients included those with peritoneum confined ovarian carcinoma (32, 57.1%), colorectal carcinoma (9, 16.1%), pseudomyxoma peritonei (7, 12.5%), meso- thelioma (2, 3.6%), gastric carcinoma (2, 3.6%) and others (4, 7.1%). The median duration of surgery including HIPEC was 9 hours and the median hospital stay was 12 days. The median time for gastrointestinal recovery was 5 days. One-fifth of patients (11, 19.7%) required an extended stay in the inten- sive care unit. The most common grades 3 and 4 complications were hypocalcaemia 32.1%, hypokalaemia 32.1%, anaemia 21.4% and thrombocytopenia 7.1%. Major morbidity requiring surgical intervention occurred in 8.9% of patients. The 60-day operative mortality was 1.8%. At a median follow-up of 16 months, 7.1% developed peritoneal recurrence, 8.9% had systemic recurrence and 7.1% succumbed to the disease. Patients with platinum-resistant ovarian carcinomas had more peritoneal recurrence (3.6%).
In patients with PSM, surgical cytoreduction and HIPEC is feasible and potentially beneficial. It can be done with low mortality and acceptable morbidity. It requires a dedicated team of surgeons, anaesthetists and intensivists and proper infrastructure.
细胞减灭术联合热灌注腹腔化疗（HIPEC）在腹膜表面恶性肿瘤（PSM）的治疗中显示出更好的肿瘤学结局。我们评估了该手术在印度患者中的可行性及围手术期结局。
在这项从2013年2月至2015年4月的前瞻性观察性研究中，我们纳入了56例PSM患者（41例女性，占73.2%）。他们的身体状况良好，要么是未经治疗的，要么是先前接受过手术和全身化疗的。他们接受了细胞减灭术，随后使用热灌注泵进行HIPEC，温度为42°C，持续30 - 90分钟。化疗方案基于原发性恶性肿瘤。收集并分析围手术期结局数据。我们还分析了短期肿瘤学结局。
我们的患者包括局限于腹膜的卵巢癌患者（32例，占57.1%）、结直肠癌患者（9例，占16.1%）、腹膜假黏液瘤患者（7例，占12.5%）、间皮瘤患者（2例，占3.6%）、胃癌患者（2例，占3.6%）以及其他患者（4例，占7.1%）。包括HIPEC在内的手术中位持续时间为9小时，中位住院时间为12天。胃肠道恢复的中位时间为5天。五分之一的患者（11例，占19.7%）需要在重症监护病房延长住院时间。最常见的3级和4级并发症为低钙血症（32.1%）、低钾血症（32.1%）、贫血（21.4%）和血小板减少症（7.1%）。需要手术干预的严重并发症发生在8.9%的患者中。60天手术死亡率为1.8%。在中位随访16个月时，7.1%的患者出现腹膜复发，8.9%的患者出现全身复发，7.1%的患者死于该疾病。铂耐药卵巢癌患者的腹膜复发更多（3.6%）。
对于PSM患者，手术细胞减灭术和HIPEC是可行的且可能有益。该手术死亡率低，发病率可接受。它需要一支由外科医生、麻醉师和重症监护医生组成的专业团队以及适当的基础设施。
