Berger Yaniv, Jacoby Harel, Zager Yaniv, Lebedyev Alexander, Gutman Mordechai, Hoffman Aviad
Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University.
Harefuah. 2019 Apr;158(4):227-232.
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for selected patients with peritoneal carcinomatosis of colorectal origin. We present our experience with the first 100 consecutive cases of this combined treatment.
CRS/HIPEC procedures were performed between 4/2009-8/2016. HIPEC was initially delivered using the "Open" abdomen technique; beginning in January 2014, HIPEC was delivered using the "Closed" technique. As a chemotherapeutic agent we used Mitomycin-C, perfused for duration of 90 minutes at 41 degrees Celsius.
A total of 100 procedures were performed in 94 patients (64% females, median age 62 (22-83) years) with colon (n=89) or rectal (n=5) cancer. Complete cytoreduction (CC score≤1) was achieved in 91 procedures. The average duration of surgery was 7.5±2.3 hours, the median number of organs resected was 2 (0-6) and the median length of hospital stay was 9 (5-101) days. Postoperative complications occurred in 54% of procedures and the incidence of major complications (Clavien-Dindo 3-4) was 12%. Three patients (3%) died within 90 days postoperatively. Higher peritoneal cancer index (PCI) score, higher number of organs resected/anastomoses created and longer duration of surgery were associated with perioperative morbidity (all p≤0.05). The median follow-up period was 2.1 years during which 50 patients died. The median overall survival (OS) and disease free survival were 3.1 years and 10.7 months, respectively; 7 patients survived ≥5 years after surgery. Higher PCI score and occurrence of major postoperative complications were associated with poorer OS.
CRS/HIPEC for peritoneal carcinomatosis of colorectal cancer origin is feasible and safe. This treatment may benefit selected patients in terms of OS.
细胞减灭术联合腹腔热灌注化疗（CRS/HIPEC）是治疗特定的结直肠源性腹膜癌患者的有效方法。我们介绍了连续100例该联合治疗病例的经验。
CRS/HIPEC手术于2009年4月至2016年8月期间进行。腹腔热灌注化疗最初采用“开放”腹部技术；从2014年1月开始，采用“封闭”技术。作为化疗药物，我们使用丝裂霉素-C，在41摄氏度下灌注90分钟。
共对94例患者（64%为女性，中位年龄62岁（22 - 83岁））进行了100例手术，其中结肠癌患者89例，直肠癌患者5例。91例手术实现了完全细胞减灭（CC评分≤1）。手术平均时长为7.5±2.3小时，切除器官的中位数量为2个（范围0 - 6个），住院时间中位数为9天（范围5 - 101天）。54%的手术出现术后并发症，严重并发症（Clavien-Dindo 3 - 4级）发生率为12%。3例患者（3%）术后90天内死亡。较高的腹膜癌指数（PCI）评分、较多的切除器官数量/吻合口数量以及较长的手术时长与围手术期发病率相关（所有p≤0.05）。中位随访期为2.1年，期间50例患者死亡。中位总生存期（OS）和无病生存期分别为3.1年和10.7个月；7例患者术后存活≥5年。较高的PCI评分和术后严重并发症的发生与较差的总生存期相关。
CRS/HIPEC治疗结直肠癌源性腹膜癌是可行且安全的。该治疗在总生存期方面可能使特定患者受益。
