Pasqual Enrico Maria, Londero Ambrogio P, Robella Manuela, Tonello Marco, Sommariva Antonio, De Simone Michele, Bacchetti Stefano, Baiocchi Gianluca, Asero Salvatore, Coccolini Federico, De Cian Franco, Guaglio Marcello, Cinquegrana Armando, Cenzi Carola, Scaringi Stefano, Macrì Antonio
Advanced Surgical Oncology Center, ASUFC, DAME, University of Udine, 33100 Udine, Italy.
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Infant Health, University of Genoa, 16132 Genova, Italy.
Cancers (Basel). 2023 Jan 18;15(3):607. doi: 10.3390/cancers15030607.
The reiteration of surgical cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients affected by recurrent peritoneal metastases is still questioned regarding safety and effectiveness. This study evaluates the safety, efficacy, and associated factors of iterative CRS combined with HIPEC. This multicentric retrospective study collected data from four surgical oncology centers, on iterative HIPEC. We gathered data on patient and cancer characteristics, the peritoneal cancer index (PCI), completeness of cytoreduction (CC), postoperative complications, and overall survival (OS). In the study period, 141 CRS-plus-HIPECs were performed on 65 patients. Nine patients underwent three iterative procedures, and one underwent five. No increased incidence of complications after the second or third procedure was observed. Furthermore, operative time and hospitalization stay were significantly shorter after the second than after the first procedure ( < 0.05). Optimal cytoreduction was achieved in more than 90% of cases in each procedure, whether first, second, or third. A five-year (5 y) OS represented 100% of the cases of diffuse malignant-peritoneal-mesotheliomas, 81.39% of pseudomyxoma peritonei, 34.67% of colorectal cancer (CRC), and 52.50% of ovarian cancer. During the second CRS combined with HIPEC, we observed a lower rate of complete cytoreduction and a non-significantly better survival in cases with complete cytoreduction (5 y-OS CC-0 56.51% vs. 37.82%, = 0.061). Concomitant hepatic-CRC-metastasis did not compromise the CRS-plus-HIPEC safety and efficacy. This multicentric experience encourages repeated CRS-plus-HIPEC, showing promising results.
对于复发性腹膜转移患者再次进行手术细胞减灭术（CRS）和腹腔热灌注化疗（HIPEC），其安全性和有效性仍存在争议。本研究评估了重复CRS联合HIPEC的安全性、疗效及相关因素。这项多中心回顾性研究收集了来自四个外科肿瘤中心的重复HIPEC数据。我们收集了患者和癌症特征、腹膜癌指数（PCI）、细胞减灭的完整性（CC）、术后并发症及总生存期（OS）的数据。在研究期间，对65例患者进行了141次CRS加HIPEC手术。9例患者接受了三次重复手术，1例接受了五次。未观察到第二次或第三次手术后并发症发生率增加。此外，第二次手术后的手术时间和住院时间明显短于第一次手术（<0.05）。在每次手术中，无论是第一次、第二次还是第三次，超过90%的病例实现了最佳细胞减灭。五年（5年）总生存期在弥漫性恶性腹膜间皮瘤病例中占100%，腹膜假黏液瘤病例中占81.39%，结直肠癌（CRC）病例中占34.67%，卵巢癌病例中占52.50%。在第二次CRS联合HIPEC期间，我们观察到细胞完全减灭率较低，而细胞完全减灭的病例生存情况虽无显著改善但较好（5年总生存期：完全减灭为56.51%，未完全减灭为37.82%，P = 0.061）。同时存在的肝CRC转移并未影响CRS加HIPEC的安全性和疗效。这项多中心经验鼓励重复进行CRS加HIPEC，显示出了有前景的结果。
