a Division of Surgical Oncology , National Cancer Centre Singapore , Singapore , Singapore.
b Duke-NUS Medical School , Singapore , Singapore.
Int J Hyperthermia. 2018 Aug;34(5):595-600. doi: 10.1080/02656736.2017.1345014. Epub 2017 Jul 26.
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been found to prolong survival in patients with peritoneal disease but is associated with significant morbidity. We evaluate the perioperative complications and the association with the chemotherapy agent used for HIPEC.
Retrospective analysis of a prospectively collected database of CRS-HIPEC cases between April 2001 and February 2016 was performed. Patients were stratified by the chemotherapy used, and perioperative complications were compared.
Out of 214 CRS-HIPEC cases, 113 procedures used Mitomycin-C(MMC), 92 used cisplatin, 8 used oxaliplatin and the HIPEC regimen for one procedure was not recorded and excluded. 94 patients (44%) suffered low-grade complications (grade I-II), and 49 patients (23%) suffered high-grade complications (grade III-V). The frequency of low-grade complications for the cisplain, oxaliplatin and MMC groups were 49%, 50% and 40%, respectively, whereas that of high-grade complications were 24%, 50% and 20%, respectively. HIPEC with platinum agents was associated with a higher rate of acute renal impairment (ARI) compared to MMC (32% and 62% for cisplatin and oxaliplatin vs. 5.6% for MMC), whereas grade IV ARI requiring dialysis occurred only in the cisplatin group (5.6%). HIPEC with oxaliplatin was associated with higher rates of post-operative bleeding (25% vs. 1.1% and 0.88%). Rates of other complications did not differ significantly between the groups receiving different HIPEC regimens.
The overall complication rates do not significantly differ after HIPEC with MMC and platinum based agents. Renal impairment tends to be more common and of greater severity when a platinum agent is used, whereas oxaliplatin is associated with significant post-operative bleeding.
细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）已被发现可延长腹膜疾病患者的生存时间，但与显著的发病率相关。我们评估围手术期并发症与 HIPEC 中使用的化疗药物之间的关系。
对 2001 年 4 月至 2016 年 2 月期间前瞻性收集的 CRS-HIPEC 病例数据库进行回顾性分析。根据使用的化疗药物对患者进行分层，并比较围手术期并发症。
在 214 例 CRS-HIPEC 病例中，113 例采用丝裂霉素 C（MMC），92 例采用顺铂，8 例采用奥沙利铂，1 例未记录和排除 HIPEC 方案。94 例（44%）发生低级别并发症（Ⅰ-Ⅱ级），49 例（23%）发生高级别并发症（Ⅲ-Ⅴ级）。顺铂、奥沙利铂和 MMC 组的低级别并发症发生率分别为 49%、50%和 40%，而高级别并发症发生率分别为 24%、50%和 20%。与 MMC 相比，含铂剂 HIPEC 更易导致急性肾损伤（ARI）（顺铂和奥沙利铂分别为 32%和 62%，而 MMC 为 5.6%），而仅在顺铂组发生 4 级 ARI 需要透析（5.6%）。含奥沙利铂的 HIPEC 更易发生术后出血（25%比 1.1%和 0.88%）。接受不同 HIPEC 方案的患者之间其他并发症的发生率无显著差异。
接受 MMC 和含铂剂 HIPEC 后，总体并发症发生率无显著差异。使用铂剂时，肾损伤更为常见且更为严重，而奥沙利铂与显著的术后出血相关。
