Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK.
Colorectal and Peritoneal Oncology Centre, The Christie Hospital, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Surg Oncol. 2021 Sep;38:101572. doi: 10.1016/j.suronc.2021.101572. Epub 2021 Apr 20.
Cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is offered in specialist centres as a treatment for peritoneal surface tumours. Despite its demonstrated efficacy, intra-abdominal recurrence occurs in 31-57% of patients. The aim of this study is to review the early and long-term outcomes in patients who undergo repeat CRS/HIPEC.
A retrospective review of a prospectively maintained database of patients who had undergone repeat CRS/HIPEC for appendiceal neoplasms and colorectal peritoneal metastases (CRPM) from 2003 to 2019 was performed at a single specialist centre. Data pertaining to both short term outcomes and survival were evaluated.
Of 1259 patients who had undergone CRS/HIPEC, 84(6.7%) underwent repeat surgery: 45(53.6%) had pseudomyxoma peritonei (PMP) secondary to low grade appendiceal mucinous neoplasms (LAMN), 21(25.0%) had appendix carcinoma and 18(21.4%) had CRPM. Demographics, intra-operative findings and short-term outcomes were comparable across tumour types and between procedures. Median (95% CI) interval between procedures was 22.7(18.9-26.6) months and was comparable between tumour types. Median (95%CI) overall survival was not reached for the cohort overall or for those with PMP, but was 61.0(32.6-89.4) months for those with appendix cancer and 76.9(47.4-106.4) months for CRPM (p=<0.001). Survival was favourable in the PMP group (HR [95%CI] 0.044 [0.008-0.262]; p = 0.000) and unfavourable in the CC2-3 at index CRS procedure group (HR [95%CI] 25.612 [2.703-242.703]; p = 0.005).
Our findings demonstrate that repeat cytoredutive surgery with HIPEC can result in favourable survival, especially for patients with PMP when complete cytoreduction is achieved at index operation. We recommend that detailed patient assessment is performed through an expert multidisciplinary team meeting (MDT).
细胞减灭术（CRS）和腹腔内热化疗（HIPEC）在专业中心被作为治疗腹膜表面肿瘤的方法。尽管其疗效已得到证实，但仍有 31-57%的患者出现腹腔内复发。本研究旨在回顾在一家专业中心接受重复 CRS/HIPEC 治疗的患者的早期和长期结果。
对 2003 年至 2019 年期间在一家专业中心接受重复 CRS/HIPEC 治疗阑尾肿瘤和结直肠腹膜转移（CRPM）的患者前瞻性维护的数据库进行回顾性分析。评估了短期和长期生存相关的数据。
在接受 CRS/HIPEC 的 1259 名患者中，有 84 名（6.7%）接受了重复手术：45 名（53.6%）为低级别阑尾粘液性肿瘤（LAMN）继发的假性粘液瘤（PMP），21 名（25.0%）为阑尾癌，18 名（21.4%）为 CRPM。不同肿瘤类型和手术之间的人口统计学、术中发现和短期结果无差异。手术间的中位数（95%CI）间隔为 22.7（18.9-26.6）个月，各肿瘤类型之间相似。总体队列的中位（95%CI）总生存期未达到，PMP 患者的中位（95%CI）总生存期也未达到，但阑尾癌患者为 61.0（32.6-89.4）个月，CRPM 患者为 76.9（47.4-106.4）个月（p<0.001）。PMP 组的生存情况良好（HR[95%CI]0.044[0.008-0.262]；p=0.000），而在初次 CRS 手术中为 CC2-3 指数的患者生存情况不佳（HR[95%CI]25.612[2.703-242.703]；p=0.005）。
我们的研究结果表明，重复细胞减灭术联合 HIPEC 可获得良好的生存结果，尤其是对于初次手术时达到完全细胞减灭的 PMP 患者。我们建议通过专家多学科团队会议（MDT）进行详细的患者评估。
