Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Department of Surgical, Oncological and Oral Sciences (di.Chir.On.S.), University of Palermo, Palermo, Italy.
Updates Surg. 2021 Aug;73(4):1443-1448. doi: 10.1007/s13304-021-01034-2. Epub 2021 Mar 29.
Peritoneal dissemination from colorectal cancer (CRC) has long been associated with unfavorable prognosis. However, in the last decades, the combination of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was able to obtain up to 30% 5-year survival rate in selected centers. Despite the wide diffusion of CRS and HIPEC, until now, there are no clear recommendations on the drug of choice for HIPEC nor its technique, and safety and efficacy data of HIPEC regimens and techniques are lacking. We performed a retrospective analysis of a prospectively maintained database of 26 CRS and mitomycin C HIPEC with CO recirculation (HIPEC-CO) for CRC peritoneal metastasis (PM) performed at our center. The main endpoints were morbidity, mortality, the temperature of perfusate during HIPEC and metabolic changes throughout the procedure. Morbidity was assessed by analysis of postoperative adverse events according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.0). Continuous variables of Arterial Blood Gas (ABG) analysis at three time-points were compared by the Student t test. There were no postoperative deaths. The overall grade 3-4 CTCAE complications rate at 30 days was 38.4%, with ten severe adverse events occurring to six (23.0%) patients. The temperature within HIPEC perfusion maintained between 41 and 42 °C in all cases and we experienced no HIPEC-related intraoperative complications. We observed a significant difference between all baseline and pre-HIPEC ABG parameters evaluated but no statistically significant differences between pre- and post-HIPEC ABG outcomes. This study shows that mitomycin C HIPEC-CO is feasible and has a safety profile comparable to that of other HIPEC techniques reported in the literature. Further research is needed to validate prospectively the safety and efficacy of this technique.
结直肠癌（CRC）的腹膜转移长期以来一直与不良预后相关。然而，在过去几十年中，细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC）的联合应用在一些选定的中心能够获得高达 30%的 5 年生存率。尽管 CRS 和 HIPEC 得到了广泛的应用，但到目前为止，对于 HIPEC 的首选药物及其技术还没有明确的建议，并且缺乏 HIPEC 方案和技术的安全性和有效性数据。我们对在我们中心进行的 26 例结直肠癌腹膜转移（PM）患者接受 CRS 和丝裂霉素 C HIPEC 联合 CO 再循环（HIPEC-CO）的前瞻性维护数据库进行了回顾性分析。主要终点是发病率、死亡率、HIPEC 期间灌洗液的温度和整个手术过程中的代谢变化。术后不良事件的发生率通过根据常见不良事件术语标准（CTCAE 版本 4.0）对术后不良事件进行分析来评估。通过学生 t 检验比较了三个时间点的动脉血气（ABG）分析的连续变量。没有术后死亡。30 天内的总体 CTCAE 3-4 级并发症发生率为 38.4%，有 10 例严重不良事件发生在 6 例（23.0%）患者中。在所有情况下，HIPEC 灌注的温度均保持在 41 至 42°C 之间，并且我们没有遇到与 HIPEC 相关的术中并发症。我们观察到所有基线和术前 ABG 参数评估之间存在显著差异，但术前和术后 ABG 结果之间没有统计学差异。这项研究表明，丝裂霉素 C HIPEC-CO 是可行的，并且具有与文献中报道的其他 HIPEC 技术相当的安全性。需要进一步的前瞻性研究来验证该技术的安全性和有效性。
