Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
J Surg Res. 2019 Sep;241:31-39. doi: 10.1016/j.jss.2019.03.036. Epub 2019 Apr 17.
Formal gastrectomy is occasionally required to achieve complete cytoreduction for patients with peritoneal surface malignancies. In addition, the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for patients with gastric cancer is increasingly being explored. Nevertheless, data on the safety of gastrectomy at the time of CRS-HIPEC are limited.
The American College of Surgeons-National Surgical Quality Improvement Program databases from 2005 to 2016 were used to identify patients who underwent CRS-HIPEC. Demographic, clinical, and perioperative outcomes were compared between patients who underwent CRS-HIPEC with and without gastrectomy.
Among 1168 patients who underwent CRS-HIPEC, 43 (4%) underwent partial (n = 20) or total (n = 23) gastrectomy. Patients who underwent gastrectomy at the time of CRS-HIPEC had a longer operative time (529.3 versus 457.6 min, P = 0.004), were more likely to need an intraoperative transfusion (32.6% versus 14.3%, P = 0.001), experienced a longer length of stay (19.0 versus 11.3 d, P < 0.001), and had a significantly greater complication rate (60.5% versus 27.9%, P < 0.001), whereas postoperative mortality was not statistically significantly different (4.7% versus 1.4%, P = 0.09). On multivariate logistic regression, gastrectomy (odds ratio [OR] 3.52, P < 0.001) was the strongest predictor of postoperative morbidity, in addition to American Society of Anesthesiologists class 4 (OR 2.82, P = 0.001), malnutrition (OR 1.63, P = 0.01), liver resection (OR 1.88, P = 0.01), and colectomy (OR 2.04, P < 0.001).
Patients undergoing gastrectomy at the time of CRS-HIPEC experience a substantial postoperative complication rate (60%) and extended length of stay (mean 19 d). These findings highlight the need for cautious patient selection and preoperative counseling before performing concomitant gastrectomy and CRS-HIPEC.
对于患有腹膜表面恶性肿瘤的患者，有时需要进行正式的胃切除术以实现完全减瘤。此外，对于胃癌患者，细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）的作用也在不断探索中。然而，关于 CRS-HIPEC 时胃切除术安全性的数据有限。
使用美国外科医师学会-国家手术质量改进计划数据库（2005 年至 2016 年）确定接受 CRS-HIPEC 的患者。比较行 CRS-HIPEC 时行胃切除术和不行胃切除术的患者的人口统计学、临床和围手术期结局。
在 1168 名接受 CRS-HIPEC 的患者中，有 43 名（4%）接受了部分（n=20）或全胃切除术（n=23）。在 CRS-HIPEC 时行胃切除术的患者手术时间更长（529.3 分钟 vs. 457.6 分钟，P=0.004），术中更可能需要输血（32.6% vs. 14.3%，P=0.001），住院时间更长（19.0 天 vs. 11.3 天，P<0.001），并发症发生率显著更高（60.5% vs. 27.9%，P<0.001），但术后死亡率无统计学差异（4.7% vs. 1.4%，P=0.09）。多变量逻辑回归显示，胃切除术（优势比[OR]3.52，P<0.001）是术后发病率的最强预测因素，此外还有美国麻醉医师学会分类 4 级（OR 2.82，P=0.001）、营养不良（OR 1.63，P=0.01）、肝切除术（OR 1.88，P=0.01）和结肠切除术（OR 2.04，P<0.001）。
在 CRS-HIPEC 时行胃切除术的患者术后并发症发生率（60%）和住院时间延长（平均 19 天）明显增加。这些发现强调了在进行同时性胃切除术和 CRS-HIPEC 之前，需要谨慎选择患者并进行术前咨询。
