Department of Surgery, St George Hospital, Sydney, NSW, Australia;
Department of Surgery, St George Hospital, Sydney, NSW, Australia.
In Vivo. 2022 Sep-Oct;36(5):2350-2356. doi: 10.21873/invivo.12966.
BACKGROUND/AIM: Up to a third of patients undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC) of appendiceal or colorectal origin receive a stoma during primary surgery. Stoma reversal provides an opportunity for second-look surgery.
We performed a retrospective analysis of prospectively collected data of patients with colorectal cancer (CRC) or high-grade appendiceal cancer (AC) from 2006 to 2021 from our database. A total of 34 consecutive stoma closure patients with no evidence of preoperative disease recurrence (tumor markers and CT scans) were compared with 141 consecutive re-do CRS/HIPEC patients with known recurrence.
Eleven patients (32.4%) were identified to have peritoneal recurrence at stoma closure. Time between first and second CRS was 12 months (4 to 64.2) in the stoma closure group vs. 24.6 months (5.8 to 119.8) in the re-do group, while median peritoneal cancer index (PCI) was 4 (3 to 6) vs. 8 (1 to 39), respectively (p=0.0143).
Second-look laparotomy during stoma closure identified unexpected PC in 32.4% of our patients with significantly lower PCI than planned re-do operations.
背景/目的：高达三分之一接受细胞减灭术 (CRS) 和腹腔热灌注化疗 (HIPEC) 治疗阑尾或结直肠来源腹膜癌 (PC) 的患者在初次手术中会接受造口术。造口还纳术为再次探查手术提供了机会。
我们对 2006 年至 2021 年数据库中连续 34 例无术前疾病复发证据（肿瘤标志物和 CT 扫描）的结直肠癌 (CRC) 或高级别阑尾癌 (AC) 患者的前瞻性收集数据进行了回顾性分析，并与 141 例已知复发的连续再行 CRS/HIPEC 患者进行了比较。
11 例（32.4%）患者在造口关闭时发现腹膜复发。造口关闭组首次和第二次 CRS 之间的时间为 12 个月（4 至 64.2），而再手术组为 24.6 个月（5.8 至 119.8），而中位腹膜癌症指数 (PCI) 分别为 4（3 至 6）和 8（1 至 39）（p=0.0143）。
造口关闭期间的再次探查手术在我们的患者中发现了 32.4%的意外 PC，其 PCI 明显低于计划的再手术。
