Petursdottir Astridur, Gunnarsson Orvar, Valsdottir Elsa B
Department of Abdominal Surgery, Landspitali University Hospital.
Departments of Medical Oncology at Landspitali University Hospital.
Laeknabladid. 2020 Jul;106(7):344-348. doi: 10.17992/lbl.2020.0708.590.
Peritoneal carcinomatosis is a known complication of colorectal cancer and has long been considered very difficult to manage. The survival has been reported to be under two years after systemic chemotherapy with or without palliative surgery. The most recent method of treatment is compiled of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) and has been suggested to significantly increase survival. The aim of this study was to research the cases of Icelandic patients undergoing this treatment overseas and the impact it has had on their disease.
A retrospective study of all Icelandic patients who have undergone CRS-HIPEC treatment abroad 2008-2017. Information was retrieved from medical records and from registry of the Icelandic Health Insurance committee of medical treatments abroad.
A total of 11 patients have undergone CRS-HIPEC treatment after having received their initial treatment in Landspitali University Hospital. All of the surgeries were performed in the United States by the same surgeon in the years 2008-2017. The group consists of 10 women and 1 man with a mean age of 53 years. The cause of peritoneal carcinomatosis was appendiceal cancer for 7 patients (67%) and colon cancer for 3 patients (27%). One patient had a primary malignancy of the peritoneum, mesothelioma. Three patients suffered complications within 30 days of surgery, 2 had infection and 1 had an anastomotic leak. Another patient had a late complication of bowel stenosis and later a fistula. Five patients have completed their five year observation period post surgery without diagnosis of recurrence and mean follow-up time was 44 months. Out of 11 patients, 10 are still alive. Five have been diagnosed with recurrence of disease.
Icelandic patients who have undergone CRS-HIPEC treatment have in most cases done well and survival is comparable to other studies. Half of the survivors did not have recurrence of disease within 5 years of surgery. Prognosis has improved since the introduction of this treatment and every reason to keep sending selected Icelandic patients abroad to receive it.
腹膜癌病是结直肠癌已知的一种并发症，长期以来一直被认为极难治疗。据报道，无论是否接受姑息性手术，全身化疗后的生存期都在两年以下。最新的治疗方法是细胞减灭术和腹腔内热灌注化疗（CRS-HIPEC），有人认为这种方法能显著提高生存率。本研究的目的是调查冰岛患者在国外接受这种治疗的病例及其对疾病的影响。
对2008年至2017年在国外接受CRS-HIPEC治疗的所有冰岛患者进行回顾性研究。信息从病历以及冰岛医疗保险委员会国外医疗登记处获取。
共有11名患者在Landspitali大学医院接受初始治疗后接受了CRS-HIPEC治疗。所有手术均于2008年至2017年在美国由同一位外科医生进行。该组包括10名女性和1名男性，平均年龄为53岁。腹膜癌病的病因是7例患者（67%）为阑尾癌，3例患者（27%）为结肠癌。1例患者原发性腹膜恶性肿瘤为间皮瘤。3例患者在术后30天内出现并发症，2例感染，1例吻合口漏。另1例患者出现肠狭窄晚期并发症，后来出现瘘管。5例患者完成了术后五年观察期，未诊断出复发，平均随访时间为44个月。11例患者中有10例仍存活。5例被诊断为疾病复发。
接受CRS-HIPEC治疗的冰岛患者大多数情况良好，生存率与其他研究相当。一半的幸存者在术后5年内未出现疾病复发。自从引入这种治疗方法以来，预后有所改善，因此完全有理由继续将选定的冰岛患者送往国外接受治疗。
