Surgical Oncology Research Laboratory, Department of Surgery & Transplantation, University Hospital of Zurich, Zurich, Switzerland.
Department of Surgery, Center for Peritoneal Carcinomatosis, Hanusch-Krankenhaus, Vienna, Austria.
Eur J Surg Oncol. 2019 Sep;45(9):1734-1739. doi: 10.1016/j.ejso.2019.03.036. Epub 2019 Mar 29.
CRS/HIPEC gained acceptance as a treatment for selected patients with peritoneal metastasis. However, the pathophysiology behind HIPEC is poorly understood, and a variety of regimens are currently in use. In this study, we describe for the first-time changes in the postoperative systemic inflammatory reaction, highly different among HIPEC treatment protocols.
HIPEC was performed with three protocols, different with regard to perfusion times and drugs: (mitomycinC/doxorubicin, 90min), (cisplatin, 90min) (oxaliplatin, 30min). Serial blood samples were assessed for C-reactive protein (CRP), white blood cells (WBC), pancreatic stone protein (PSP) and bacterial component (16s rDNA). The study was approved by the local ethics committee and registered at clinicaltirals.gov (NCT02741167).
Overall, 140 patients from two European centers were included. In patients without postoperative complications, a secondary peak of inflammatory parameters, CRP (p = 0.015) and PSP (p = 0.004) was observed after HIPEC for 90 min with mitomycinC/doxorubicin or cisplatin but not after 30 min oxaliplatin. In patients after 90 min HIPEC, postoperative serum bacterial 16srDNA level were 2.1 times higher (95% CI 0.646-3.032, p = 0.015) compared to 30 min oxaliplatin.
In conclusion, we identified a secondary inflammatory reaction after 90 min HIPEC, either with mitomycinC/doxorubicin or cisplatin, not observed after short course HIPEC with oxaliplatin. This protocol dependent physiology of acute phase proteins should be known in the clinical management of patients after HIPEC.
CRS/HIPEC 已被接受为治疗特定腹膜转移患者的方法。然而，HIPEC 的病理生理学机制尚未完全阐明，目前有多种方案在应用。本研究首次描述了 HIPEC 治疗方案之间术后全身炎症反应的差异。
采用三种不同的 HIPEC 方案：（丝裂霉素 C/阿霉素，90 分钟）、（顺铂，90 分钟）和（奥沙利铂，30 分钟）。连续采集血液样本，检测 C 反应蛋白（CRP）、白细胞（WBC）、胰腺结石蛋白（PSP）和细菌成分（16s rDNA）。本研究经当地伦理委员会批准，并在 clinicaltrials.gov 注册（NCT02741167）。
共纳入来自两个欧洲中心的 140 例患者。在无术后并发症的患者中，采用丝裂霉素 C/阿霉素或顺铂行 90 分钟 HIPEC 后，CRP（p=0.015）和 PSP（p=0.004）出现二次炎症参数高峰，但采用奥沙利铂行 30 分钟 HIPEC 后无此高峰。90 分钟 HIPEC 后，术后血清细菌 16srDNA 水平升高 2.1 倍（95%CI：0.646-3.032，p=0.015）。
总之，我们发现采用丝裂霉素 C/阿霉素或顺铂行 90 分钟 HIPEC 后会出现二次炎症反应，而采用奥沙利铂行短时间 HIPEC 则无此反应。这种方案依赖性的急性期蛋白生理学机制应在 HIPEC 后患者的临床管理中得到认识。
