Hayler Raymond, Lockhart Kathleen, Barat Shoma, Cheng Ernest, Mui Jasmine, Shamavonian Raphael, Ahmadi Nima, Alzahrani Nayef, Liauw Winston, Morris David
Peritonectomy and Liver Cancer Unit, Department of Surgery, St George Hospital, NSW, Sydney, Australia.
School of Clinical Medicine, St George & Sutherland Campus, UNSW Medicine & Health, Sydney, Australia.
Pleura Peritoneum. 2023 Mar 16;8(1):27-35. doi: 10.1515/pp-2022-0205. eCollection 2023 Mar.
Appendiceal cancer is a rare malignancy, occurring in roughly 1.2 per 100,000 per year. Low grade appendiceal neoplasams (LAMN) in particular can lead to pseudomyxoma peritonei (PMP), and respond poorly to systemic chemotherapy. Standard treatment includes cytoreduction surgery (CRS) with addition of heated intraoperative peritoneal chemotherapy (HIPEC). Several centres include early postoperative intraperitoneal chemotherapy (EPIC) however; the literature is mixed on the benefits. We aim to examine the benefits of additional EPIC through a propensity-matched analysis.
Patients with LAMN with PMP who underwent cytoreductive surgery at St George hospital between 1996 and 2020 were included in this retrospective analysis. Propensity score matching was performed with the following used to identify matched controls; sex, age, American Society of Anesthesiologists (ASA) grade, peritoneal cancer index (PCI) and morbidity grade. Outcomes measured included length of stay and survival.
A total of 224 patients were identified of which 52 received HIPEC alone. Propensity matching was performed to identify 52 matched patients who received HIPEC + EPIC. Those receiving HIPEC + EPIC were younger at 54.3 vs. 58.4 years (p=0.044). There was a median survival benefit of 34.3 months for HIPEC + EPIC (127.3 vs. 93.0 months, p=0.02). Median length of stay was higher in those who received EPIC (25.0 vs. 23.5 days, p=0.028).
In LAMN with PMP, the addition of EPIC to HIPEC with CRS improves overall survival in propensity score matched cases but results in prolonged hospitalisation. The use of EPIC should still be considered in selected patients.
阑尾癌是一种罕见的恶性肿瘤，每年发病率约为十万分之一点二。尤其是低级别阑尾肿瘤（LAMN）可导致腹膜假黏液瘤（PMP），且对全身化疗反应不佳。标准治疗包括减瘤手术（CRS）并加用术中热灌注化疗（HIPEC）。不过，有几个中心采用术后早期腹腔内化疗（EPIC）；关于其益处的文献报道不一。我们旨在通过倾向评分匹配分析来研究额外使用EPIC的益处。
本回顾性分析纳入了1996年至2020年间在圣乔治医院接受减瘤手术的LAMN合并PMP患者。采用倾向评分匹配法，以下因素用于确定匹配对照：性别、年龄、美国麻醉医师协会（ASA）分级、腹膜癌指数（PCI）和并发症分级。测量的结局指标包括住院时间和生存率。
共纳入224例患者，其中52例仅接受HIPEC。进行倾向评分匹配以确定52例接受HIPEC + EPIC的匹配患者。接受HIPEC + EPIC的患者更年轻，分别为54.3岁和58.4岁（p = 0.044）。HIPEC + EPIC组的中位生存获益为34.3个月（127.3个月对93.0个月，p = 0.02）。接受EPIC的患者中位住院时间更长（25.0天对23.5天，p = 0.028）。
在LAMN合并PMP患者中，CRS联合HIPEC并加用EPIC可提高倾向评分匹配病例的总生存率，但会导致住院时间延长。对于部分患者仍应考虑使用EPIC。
